Value of ST-segment change in lead aVR in diagnosing left main disease in Non-ST-elevation acute coronary syndrome - a meta-analysis

[[abstract]]背景：先前的研究證明，aVR導聯的ST段抬高（ST-segment elevation, STE）對預測左主幹病變或嚴重的多支血管病變具有重要意義。當前的研究是總結已發表的數據，並評估非ST段抬高的急性冠狀動脈綜合徵中aVR導聯的STE與左主冠狀動脈疾病（left main coronary artery disease, LMD）的相關性。 方法：線上數據庫中進行文獻檢索，並根據檢索結果進行系統性文獻回顧，並分析aVR導聯中有意義的STE，並計算勝算比（OR）和95％信賴區間（95％CI）。 結果：包括27篇論文作為最終數據分析。與STE <0.05mV相比，STE≥0.05mV的LMD發生率更高（OR = 6.64，95％CI：4.80〜9.17），且aVR導聯的STE程度越大與LMD相關性越高。另外STE≥0.05mV的患者比STE <0.05mV的患者更容易發生心肌梗塞（OR = 3.12，95％CI：1.73〜5.62）。 結論：aVR導聯的STE和STE的程度是診斷LMD或心肌梗塞的獨立預測因子。 Background: Previous researches proved that the ST-segment elevation (STE) in lead aVR had great significance on the prediction of severe left main lesion or serious multi-vessel lesions. The current research is to summarize the published data and evaluate the overall association of STE in lead aVR and left main coronary artery disease (LMD) in Non-ST-elevation acute coronary syndrome. Methods: Literature searching was performed in the online database and a systematic review was conducted based on the searched results. Meaningful STE in lead aVR was summarized and analyzed for odds ratio (OR) and 95% confidence intervals (95% CI). Results: Twenty-seven papers were included for final data analysis. Compared with STE<0.05mV, STE≥0.05mV was associated with a higher incidence rate of LMD (OR=6.64, 95% CI:4.80~9.17), and the degree of STE in lead aVR was significantly associated with LMD. Myocardial infarction was more likely to occur in patients with STE≥0.05mV than in patients with STE