Objectives: To study the relation between lead aVR ST segment elevation (aVRSTE) and angiographic coronary artery lesions in patients with acute coronary syndrome (ACS).
Material and Method: From January 2001 to December 2001, the authors retrospectively studied 26 consecutive patients who were admitted to the coronary care unit, Chest disease Institute with ACS. The admission 12-lead EKGs,chest X-ray, troponin T, creatine phosphokinase (CPK), creatine kinase MB fraction (CK
MB) and blood chemistry including fasting blood sugar, renal function test (BUN and creatinine), electrolytes and lipid profiles were obtained and analyzed before coronary angiogram. CAG was performed in all within 48 hours after admission. The admission 12-lead EKGs and angiographic coronary artery lesions were analyzed.
Results: There were 26 patients (M:F = 21:5) with a mean age of 64 + 9 yr.The culprit lesions were located at the left main coronary artery (LM) in 5 (19%), the left anterior descending artery (LAD) in 8 (31%), the right coronary artery (RCA) in 11 (42%) and the left circumflex artery (LCX) in 2 (8%). Of these, aVRSTE (> 0.1 mV) was detected in 9 (35%), 4 in the LM group (80%). 3 in the RCA group (27%) and 2 in the LAD group (25%). The findings of aVRSTE distinguished the LM group from the non LM group (LAD, RCA and LCX ), with 80% sensitivity, 76% specificity and 77% accuracy.
Conclusion: In patients with acute coronary syndrome, lead AVR ST segment elevation is associated with the culprit left main coronary lesion.

Keywords: Lead aVR ST segment evaluation (aVRSTE), Acute coronary syndrome (ACS), Electrocardiography (ECG)