The objective of our study was to determine the significance of changes in lead aVR in patients with acute coronary syndromes, its role in predicting adverse prognosis and the occurrence of complications in these patients.

The study contained 120 study participants in a tertiary care hospital presenting with acute coronary syndrome. Standard 12-lead ECG was taken on admission, after thrombolysis (if required), six hour after admission, twenty four hours after admission and daily till the patient remained in the ICCU. The relevant history regarding chief complaints, risk factors for atherosclerosis were taken and each patient examined for vital signs and signs of cardiac failure.

ST elevation in lead aVR was found in 17% of patients of Anterior wall STEMI. ST depression was seen in lead aVR in patients of Inferior wall STEMI. Complications like Left Ventricular Failure, Hypotension and Death were significantly more in groups having changes in lead aVR in patients of Acute Coronary Syndrome. Death was significantly higher in patients of Anterior wall STEMI who had changes in lead aVR.