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Introduction: Among the 12 leads studied in electrocardiography (ECG), lead aVR can be considered as the most forgotten part of it since no attention is paid to it as the mirror image of other leads. Therefore, the present study has been designed with the aim of evaluating the prevalence of ST segment changes in lead aVR and its relationship with the outcome of these patients.Methods: In this retrospective cross sectional study medical profiles of patients who had presented to emergency department with the final diagnosis of myocardial infarction (MI) in a 4-year period were evaluated regarding changes of ST segment in lead aVR and its relationship with in-hospital mortality, the number of vessels involved, infarct location and cardiac ejection fraction.Results: 288 patients with the mean age of 59.00 ± 13.14 (18 – 91) were evaluated (79.2% male). 168 (58.3%) patients had the mentioned changes (79.2% male). There was no significant relationship between presence of ST changes in lead aVR with infarct location (p = 0.976), number of vessels involved (p = 0.269) and ejection fraction on admission (p = 0.801). However, ST elevation ≥ 1 mv in lead aVR had a significant relationship with mortality (Odds = 7.72, 95% CI: 3.07 – 19.42, p < 0.001). Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of ST elevation ≥ 1 for prediction of in-hospital mortality were 41.66 (95% CI: 22.79 – 63.05), 91.53 (95% CI: 87.29 – 94.50), 31.25 (95% CI: 16.74 – 50.13), 94.44 (95% CI: 90.65 – 96.81), 0.45 (95% CI: 0.25 – 0.79), and 0.05 (95% CI: 0.03 – 0.09), respectively.Conclusion: Based on the results of the present study, the prevalence of ST segment changes in lead aVR was estimated to be 58.3%. There was no significant relationship between these changes and the number of vessels involved in angiography, infarct location and cardiac ejection fraction. However, presence of ST elevation ≥ 1 in lead aVR was associated with 8 times increase in in-hospital mortality risk.

Quantifying the quality of care in high-cost and fatal conditions such as acute myocardial infarction (AMI) is a crucial step toward improving clinical outcomes in these patients. The main objective of this pilot study is to show whether abstraction of medical charts would be a useful method to systematically assess quality of care in patients hospitalized for AMI in a general hospital that has no interventional cardiac technology.A general physician and a cardiologist working with Shahid Gholipour Hospital in Bukan, Northwest Iran, retrospectively abstracted medical records of all patients with verified diagnoses of myocardial infarction who were hospitalized between April 1, 2010 and March 31, 2011. The targeted outcome variables were risk-adjusted mortality and risk-adjusted length of hospital stay. Process quality indicators were selected from those developed by the National Quality Forum (NQF) of the United States. We reported completeness of selected variables used to build and calculate quality indicators in this study.For most variables, missing values were negligible. However, missing data on fields related to contraindications for prescribed medications were common.Medical chart abstractions provide useful first steps in assessing differences in the quality of hospital care for patients with AMI. Extension of our pilot study is highly recommended and may help trigger policy decisions to promote hospital quality in Iran.

A 37-year-old man, a known case of Behcet's disease with its vascular complications such as abdominal and thoracic artery aneurysms, was admitted with the diagnosis of acute anterior myocardial infarction and received thrombolytic therapy. Coronary angiography and percutaneous coronary intervention via transradial approach were performed for the patient on the eighth day of admission. The patient did not suffer from any symptoms, myocardial infarction, or readmission in the nine-month follow-up. About 25 cases of myocardial infarction associated with Behcet's disease have been reported previously. Although coronary involvement is rare in Behcet's disease, it is especially important because it affects young individuals and often presents as acute coronary syndromes.