الفهرس 
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Abstract
E
lectrocardiography is an appropriate bedside tool used in the Emergency Department to make a rapid diagnosis of ACS, allowing physicians to select appropriate therapy and to predict potential cardiovascular complications. The ability to discriminate among the various coronary artery obstruction patterns may influence early management decisions. In patients with non-ST-segment elevation myocardial infarction (NSTE-MI), identification of left main and/or 3-vessel disease (LM/3VD) is crucial for prediction of the angiographic severity and the possibility of surgical intervention in such condition.
The clinical TIMI risk score, a simple 7-points tool was developed to stratify NST-EACS patients into low, intermediate & high risk groups. Although it correlated well with the severity of CAD with each increase in the score, it was found to be less sensitive in low & intermediate risk populations. Thus TIMI score needs more additive tools to stratify patients for the proper treatment strategy. The aim of this study was to investigate the added value of the presence of ST-segment elevation in lead aVR of the 12 lead admission electrocardiogram to the TIMI clinical scoring system in predicting the severity of coronary artery disease by doing coronary angiography for 150 patients presenting to ED with NSTEMI.
150 patients (85 males / 65 females) who underwent coronary angiograms in Ain Shams University Hospital were the subjects of the study. All patients were subjected to full history taking, clinical evaluation, laboratory investigations, serial ECGs, TIMI scoring & coronary angiography.
Out from the 150 patients, 137 patients was found to have significant CAD with 93 of them had ST elevation in aVR lead, and none of the normal CA cases had elevated ST in this lead. Of the 93 with STE-aVR 34 patients had left main disease and 75 of them had multi-vessel disease. ST-aVR was elevated in 55 cases with low or intermediate risk TIMI score (20.8% & 73.5% of both groups respectively), and was normal in 20 (52.6%) of the high risk TIMI score patients.
Thus STE aVR could predict another 40.1% of high risk cases who would not be detected by TIMI.
These findings suggest that STE-aVR in admission ECG may be of a great predictive value of the severity of the CAD either left main disease or three vessel disese among patient populations stratified by TIMI scoring system as low & intermediate risk groups.
We conclude that our study is important since it allowed rapid evaluation of patients by two simple non-invasive tools (TIMI & ECG STE-aVR) identifying patients with possible high risk angiographic results and helping to decide the proper management strategy for them.