Value of ST segment elevation in lead aVR and QRS duration on electrocardiogram for assessing the risk of cardiogenic shock in patients with acute anterior myocardial infarction

doi:10.3969/j.issn.1004-583X.2026.08.002

Abstract

Abstract:

Objective To investigate the value of ST segment elevation in lead aVR and QRS duration on electrocardiogram for assessing the risk of cardiogenic shock (CS) in patients with acute anterior myocardial infarction (AAMI).Methods A total of 178 patients with AAMI admitted to our hospital from October 2022 to October 2025 were retrospectively enrolled. According to the occurrence of CS, patients were divided into a CS group (46 cases) and a non-CS group (132 cases). Clinical data were compared between the two groups. Univariate and multivariate logistic regression analyses were used to evaluate the risk of CS in patients with AAMI. Results The proportions of patients with Killip class ≥ III and left ventricular ejection fraction (LVEF) <50% were significantly higher in the CS group than in the non-CS group, and the magnitude of ST segment elevation in lead aVR and QRS duration were also greater in the CS group (P<0.05). Multivariate logistic regression analysis showed that Killip class, LVEF <50%, ST segment elevation in lead aVR, and QRS duration were risk factors for cardiogenic shock in patients with AAMI (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the areas under the curve for ST segment elevation in lead aVR and QRS duration alone, as well as in combination, in predicting cardiogenic shock in patients with AAMI were 0.812, 0.785, and 0.935, respectively; the corresponding sensitivities were 0.761, 0.739, and 0.848, and the specificities were 0.758, 0.765, and 0.886. Conclusion ST segment elevation in lead aVR and prolonged QRS duration on electrocardiogram are independent risk factors for cardiogenic shock in patients with AAMI. Combined detection of these two indicators may serve as an auxiliary marker for early identification of CS risk in patients with AAMI, thereby facilitating the identification and intervention of high-risk patients in clinical practice.

Key words: anterior myocardial infarction, cardiogenic shock, aVR lead, ST segment elevation, QRS wave duration

CLC Number:

R542.22

Zhou Lili, Yan Xia, Yan Jin. Value of ST segment elevation in lead aVR and QRS duration on electrocardiogram for assessing the risk of cardiogenic shock in patients with acute anterior myocardial infarction[J]. Clinical Focus, 2026, 41(8): 685-689.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.08.002

https://www.lchc.cn/EN/Y2026/V41/I8/685

Figures/Tables 4

References 18

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单因素	CS组(n=46)	非CS组(n=132)	χ²/t值	P值
年龄(岁)	63.52±10.73	62.69±10.37	0.463	0.644
性别[例(%)]
男女	30(65.22) 16(34.78)	84(63.64) 48(36.36)
BMI(kg/m²)	24.79±3.08	24.48±3.31	0.557	0.579
高血压史[例(%)]
有无	28(60.87) 18(39.13)	76(57.58) 56(42.42)	0.152	0.696
糖尿病史[例(%)]
有无	15(32.61) 31(67.39)	39(29.55) 93(70.45)	0.152	0.697
血脂异常[例(%)]
有无	26(56.52) 20(43.48)	62(46.97) 70(53.03)	1.245	0.264
吸烟史[例(%)]
有无	23(50.00) 23(50.00)	61(46.21) 71(53.79)	0.196	0.658
收缩压(mmHg)	120.74±16.59	125.62±19.58	1.511	0.133
舒张压(mmHg)	74.66±12.81	77.46±13.53	1.225	0.222
心率(次/min)	84.72±16.34	81.59±15.62	1.156	0.249
Killip分级[例(%)]
≥Ⅲ级 <Ⅲ级	29(63.04) 17(39.96)	40(30.30) 92(69.70)	15.404	0.000
罪犯血管前降支[例(%)]
是否	41(89.13) 5(10.87)	115(87.12) 17(12.88)	0.127	0.721
多支血管病变[例(%)]
是否	28(60.87) 18(39.13)	72(54.55) 60(45.45)	0.554	0.457
LVEF[例(%)]
≥50% <50%	5(10.87) 41(89.13)	65(49.24) 67(50.76)	21.051	0.000
cTnI(μg/L)	11.95±2.73	11.26±2.38	1.629	0.105
CK-MB(μg/L)	81.36±26.75	75.65±23.29	1.377	0.170
NT-proBNP(ng/L)	1812.36±581.71	1776.53±533.79	0.383	0.702
hs-CRP(mg/L)	17.37±4.42	16.59±3.71	1.167	0.245
aVR导联ST段抬高(mV)	0.17±0.05	0.13±0.04	5.461	0.000
QRS波时限(ms)	112.81±14.77	97.82±10.59	7.419	0.000

单因素	CS组(n=46)	非CS组(n=132)	χ²/t值	P值
年龄(岁)	63.52±10.73	62.69±10.37	0.463	0.644
性别[例(%)]
男女	30(65.22) 16(34.78)	84(63.64) 48(36.36)
BMI(kg/m²)	24.79±3.08	24.48±3.31	0.557	0.579
高血压史[例(%)]
有无	28(60.87) 18(39.13)	76(57.58) 56(42.42)	0.152	0.696
糖尿病史[例(%)]
有无	15(32.61) 31(67.39)	39(29.55) 93(70.45)	0.152	0.697
血脂异常[例(%)]
有无	26(56.52) 20(43.48)	62(46.97) 70(53.03)	1.245	0.264
吸烟史[例(%)]
有无	23(50.00) 23(50.00)	61(46.21) 71(53.79)	0.196	0.658
收缩压(mmHg)	120.74±16.59	125.62±19.58	1.511	0.133
舒张压(mmHg)	74.66±12.81	77.46±13.53	1.225	0.222
心率(次/min)	84.72±16.34	81.59±15.62	1.156	0.249
Killip分级[例(%)]
≥Ⅲ级 <Ⅲ级	29(63.04) 17(39.96)	40(30.30) 92(69.70)	15.404	0.000
罪犯血管前降支[例(%)]
是否	41(89.13) 5(10.87)	115(87.12) 17(12.88)	0.127	0.721
多支血管病变[例(%)]
是否	28(60.87) 18(39.13)	72(54.55) 60(45.45)	0.554	0.457
LVEF[例(%)]
≥50% <50%	5(10.87) 41(89.13)	65(49.24) 67(50.76)	21.051	0.000
cTnI(μg/L)	11.95±2.73	11.26±2.38	1.629	0.105
CK-MB(μg/L)	81.36±26.75	75.65±23.29	1.377	0.170
NT-proBNP(ng/L)	1812.36±581.71	1776.53±533.79	0.383	0.702
hs-CRP(mg/L)	17.37±4.42	16.59±3.71	1.167	0.245
aVR导联ST段抬高(mV)	0.17±0.05	0.13±0.04	5.461	0.000
QRS波时限(ms)	112.81±14.77	97.82±10.59	7.419	0.000

变量	â	标准误	Waldχ²值	P值	OR值	95%CI
Killip分级	1.016	0.364	7.770	0.005	2.762	1.352~5.642
LVEF<50%	0.913	0.314	8.466	0.004	2.491	1.347~4.607
aVR导联ST段抬高	0.806	0.285	8.005	0.005	2.239	1.281~3.913
QRS波时限	0.766	0.269	8.093	0.004	2.151	1.269~3.646
年龄	0.152	0.203	0.560	0.454	1.164	0.782~1.733
性别	-0.087	0.315	0.076	0.783	0.917	0.495~1.699

变量	â	标准误	Waldχ²值	P值	OR值	95%CI
Killip分级	1.016	0.364	7.770	0.005	2.762	1.352~5.642
LVEF<50%	0.913	0.314	8.466	0.004	2.491	1.347~4.607
aVR导联ST段抬高	0.806	0.285	8.005	0.005	2.239	1.281~3.913
QRS波时限	0.766	0.269	8.093	0.004	2.151	1.269~3.646
年龄	0.152	0.203	0.560	0.454	1.164	0.782~1.733
性别	-0.087	0.315	0.076	0.783	0.917	0.495~1.699

指标	曲线下面积	标准误	95%CI	截断值	敏感度	特异度
aVR导联ST段抬高	0.812	0.045	0.724~0.900	0.16 mV	0.761	0.758
QRS波时限	0.785	0.049	0.689~0.881	108.50 ms	0.739	0.765
联合检测	0.935	0.024	0.888~0.982	0.637	0.848	0.886