Up until recently there were actually very limited options for sustain runes. You either used flat Hp5 Quints or you didn't use sustain runes at all. The alternatives, flat Hp5 Seals/Glyphs and scaling Hp5 Quints, were too inefficient and ineffective to be serious options. It took the addition of Life Steal and Spell Vamp Quints to give players a reason to consider the possibilities of sustain runes again.
Before comparing sustain runes against one another, it's important to remember that they are also in competition with other rune types as well. To use sustain runes is to sacrifice potential offense, defense, or another form of utility. Though I'll be examining sustain runes only in the context of their peers, always keep in mind the opportunity costs of your choices.
Of the sustain runes, flat Hp5 rune are the safest option. A full set of flat Hp5 Quints heal for as much as a potion every minute and a half, a substantial amount during the early game. They are also effective in many situations where Life Steal and Spell Vamp are not, such as while hiding under a tower or camping brush. Overall flat Hp5 is stronger than its peers early on, but loses effectiveness as the game progresses.
Life Steal and Spell Vamp are not as safe as flat Hp5, but provide significant benefits later. For a laner these runes are risky because their early healing is half that of flat Hp5 unless you are in a position to auto-attack or spam spells, and drops to nothing if you get zoned. For a jungler flat Hp5 becomes more effective the moment you do anything outside of farm. However, Life Steal and Spell Vamp quickly outscale flat Hp5 as your damage increases, and their immediate returns are better during skirmishes and fights. Offense-oriented champions favor these runes for their mid and late-game power.
As examples, here are some situations where I use each type of rune:
- Flat Hp5: I typically use these when jungling Dr. Mundo. They allow me to start Boots and 3 potions and still gank. Flat Hp5 is preferable to Spell Vamp and Life Steal because it already heals slightly more than them while clearing the jungle, but also heals while traveling to lanes to gank or ward.
- Life Steal: These are my go to runes when I have to play an AD carry with a non-sustain support, especially when I'm against a lane which is likely to push and force me to auto-attack minions. I'll even start with a Doran's Blade, giving me a total of 12% Life Steal at the very outset. When simply last-hitting heals you for as much as a potion every minute it's not the end of the world to lane without them.
- Spell Vamp: Obviously I use them when playing jungle Akali for fun, but they're also useful on AP champions who can freely spam their spells (typically but not always resourceless champions). When I'm on a champion who's going to be running Revolver or WotA later, these are a prime choice for me.
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