Abstract：BackgroundAcute pulmonary embolism (APE) is a potentially lifethreatening disease. Accurate diagnosis and adequate specific therapy couldsave patients life or reduce short and long term sequelae, in which risk stratification is useful, but is at higher challenging.ObjectiveTo access the impact of ST-segment elevation in lead aVR and other known APErelated ECG pattern on risk stratification in patients with proven APE, by introducing a multicenter study. Methods Three hundred and ninety-six consecutive patients with proven APE were retrospectively analysed with respect to 12-lead ECG, symptoms, thrombus location, echocardiography, troponin T, initial therapy and outcome. Data were then compared between patients with and without aVR ST-segment elevation. Results On admission，aVR STsegment elevation was present in 34.3%. Presence of aVR STsegment elevation was associated with more severe clinical presentation (dyspnoea at rest，44.9% vs 29.2% ，P=0.002； hypotension，17.0% vs 6.5%，P=0.001； syncope，16.2% vs 6.5%，P=0.002),troponin T levels (0.035 vs 0.01, P<0.001), more frequent right ventricular dysfunction (74.5% vs 46.6%，P<0.001) and central located thrombi (50.8% vs 29.2%，P<0.001). Mortality in patients with aVR STsegment elevation was 8.9% compared to 0% in those without aVR ST-segment elevation (P=0.04). Conclusion ST-segment elevation in lead aVR is associated with a more severe course of APE, especially in patients with intermediate risk. Therefore, ST-segment elevation in lead aVR is useful for risk stratification inpatients with APE.
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