Background Red cell distribution width (RDW) reflects the volumetric heterogeneity of red blood cells (RBCs) and has proven to be a prognostic predictor for cardiovascular (CV) morbidity and mortality in ST-elevation myocardial infarction (STEMI). The study aims to evaluate the effect of the RDW admission value on the outcome of patients with STEMI. Materials and methods This is a cross-sectional observational study on (207) patients with first-ever STEMI, grouped according to their baseline RDW and thrombolysis eligibility into two groups. We calculated the in-hospital Global Registry of Acute Coronary Events (GRACE) score within 48 hours of presentation. Results The study demonstrated the impact of RDW on the primary STEMI outcomes (left ventricular ejection fraction (LVEF%), ST-resolution, arrhythmias, and cardiovascular mortality risk). It was nearly a gender-matched study, with a mean RDW of 14.20±1.86%. RDW>14% and age≥65 years were the strongest statistically significant independent predictors of STEMI outcome with LVEF % < 45%, ST-resolution, and CV mortality regardless of thrombolysis. The thrombolysis offers a logical significant negative relation with CV mortality. At the same time, hypertension, diabetes mellitus (DM), and smoking may cause an additional mortality burden, especially in elderly patients with high RDW who are not eligible for thrombolysis. There was a significant association between high GRACE to high RDW, with excellent specificity and sensitivity in predicting CV outcome. Conclusion The RDW is a simple to acquire index, with a good prognostic prediction of major adverse cardiovascular events (MACEs) and CV mortality in the STEMI patients. It is excellent in predicting STEMI outcomes, especially the response to thrombolysis.

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Background:The incidence of mortality and complications are high in patients with acute inferior wall ST-segment elevation myocardial infarction with right ventricular involvement, which has been reported to be an independent predictor of significant complications and in-hospital mortality. Objective:To investigate the feasibility of using electrocardiographic changes in inferior myocardial infarction represented by ST-segment elevation ratio in lead II and III as a predictor of right ventricular infarction and in-hospital morbidity and mortality. Methods:Ninety-nine patients were studied in this prospective study, their ages ranged from 19-90 years, average 58.12 (±12.7 SD). They were presented to the Coronary Care Unit of Basrah General Hospital with acute inferior ST-segment elevation myocardial infarction. The 12 leads plus right-sided precordial electrocardiograms were done to all patients within 12 hours of the onset of symptoms, and ST-segment elevation was measured. ST-segment elevation in lead III exceeding lead II was defined as a ratio of elevation in lead III: II>1. Patients grouped according to ST-segment elevation III:II ratio into either >1 or ≤1. In-hospital morbidity and mortality were studied in both groups. Results:ST-segment elevation ratio > 1was detected in 68 patients (68.7%) with acute inferior myocardial infarction at time of admission. Right ventricular infarction was diagnosed in 33 (33.3%) patients, with the majority (32 patients) have ST-elevation ratio > 1. Thirty-Six patients had at least one of the in-hospital complications with significantly higher incidence (51.4%) in patients with higher ST elevation ratio. The mortality was statistically higher when ST segment elevation level in the lead III > than that in the lead II. Conclusion:In patients with inferior STEMI, ST-segment elevation in the lead III more than lead II can be a potential marker of the presence of right ventricular infarction in association with inferior myocardial infarction. Short-term prognosis is possibly worse in the presence of a higher ratio between lead III and II ST-segment elevation. However, further studies are needed to validate this conclusion. Keywords:Inferior MI, right ventricular infarction, ST-segment changes Citation:Al-Mansouri LA, Al-Obaidi FR, Al-Humrani AH. Higher ST-Segment elevation in lead III than lead II in acute inferior myocardial infarction can be a predictor of short-term morbidity and mortality. Iraqi JMS. 2019; 17(3&4): 168-174. doi: 10.22578/IJMS.17.3&4.2