Inferior ST segment depression during acute anterior myocardial infarction: Clinical and angiographic correlations

Abstract

This study was performed to determine whether inferior ST segment depression during early stages of acute transmural anterior myocardial infarction identifies patients with multivessel coronary artery disease and additional inferior ischemia. Coronary and left ventricular angiography were performed within 3.4 months in 33 patients with acute transmural anterior infarction. Initial electrocardiograms, 2 to 5 hours after onset of chest pain, revealed significant ST segment depression (greater than or equal to 0.1 mV) in at least two of leads II, III and a VF in 15 patients (45%) (group B); in 18 patients (group A) this finding was absent. Compared with group A, patients in group B had greater anterior ST elevation (1.2 versus 0.7 mV, p less than 0.025); higher serum peak creatine kinase (2,475 versus 1,147 IU/liter, p less than 0.005); higher Killip scores (2.1 versus 1.3, p less than 0.001); more in-hospital complications (60 versus 17%, p less than 0.05); lower mean left ventricular ejection fraction (34 versus 55%, p less than 0.001); more frequent regional left ventricular dysfunction in anterolateral (91 versus 44%, p less than 0.05), posterolateral (36 versus 0%, p less than 0.05) and inferior (100 versus 6%, p less than 0.005) regions; greater wall motion abnormality scores (10.0 versus 5.5, p less than 0.005); higher frequency of concomitant left circumflex or right coronary artery disease, or both (80 versus 28%, p less than 0.01); more frequent postinfarction angina (100 versus 39%, p less than 0.001) and lower New York Heart Association functional classification scores (1.7 versus 2.4, p less than 0.05) at 6 month follow-up. The time course of inferior ST depression differed from that of anterior ST elevation. Thus, inferior ST depression was maximal in the first 48 hours and decreased (p less than 0.05) thereafter. In contrast, ST elevation in leads V1 to V6 and I appeared to decrease (p = NS) between days 4 and 7. However, inferior ST depression "mirrored" ST elevation in lead aVL, which also decreased (p less than 0.05) after 48 hours. Thus, inferior ST depression during anterior infarction is associated with more extensive infarction, greater morbidity and higher frequency of multivessel coronary disease. Such inferior ST depression might reflect not only "reciprocal change," but also ischemia in adjacent lateral and remote inferior regions.

Lack of ST-Segment Depression Normalization After PCI is a Predictor of 5-Year Mortality in Patients With ST-Elevation Myocardial Infarction

“…ST-depression, seen as the reciprocal changes in the ECG tracings, is probably the effect of a larger ischemic area in remote myocardium during STEMI, regarding or according to total occlusion of the infarct-related artery, and affects mortality accordingly. Previous studies reported a correlation between the presence of reciprocal changes and multivessel disease, 4 and we have found also a correlation between poor STN and 3-vessel disease. Thus, worse longterm mortality in cases of poorer STN may be at least partly influenced by multivessel disease.…”

“…3 Furthermore, inferior ST-segment depression during an anterior infarction was shown to be associated with more extensive infarction, greater morbidity and higher frequency of multivessel coronary disease, which suggested that ST depression was not a reciprocal change, but rather ischemia in adjacent remote regions. 4 However, the significance of the dynamic changes in the reciprocal ST-segment depression after interventional treatment of patients with STEMI is unknown and became the aim of this study.…”

Angiographic and Clinical Significance of `Transient' ST-Segment Depression in the Lateral Chest Leads in Anterior Wall Acute Myocardial Infarction

“…However, in the present study, there was no difference in the frequency of patients with ST-segment depression in the inferior leads between patients with and without ST-segment depression in the lateral chest leads. Considering the results of the present study and previous studies with regard to STsegment depression in the inferior leads in anterior wall AMI, 4,6,8,12,13,19 there may be some differences in infarct size and prognosis between patients with ST-segment depression in the inferior leads and those with ST-segment depression in the lateral chest leads. Further investigation is Japanese Circulation Journal Vol.63, November 1999 needed to precisely clarify any differences in clinical features according to the site of ST-segment depression in anterior wall AMI.…”

“…6,8,12,19 Therefore, the frequency of patients with ST-segment depression in the inferior leads could affect our results. However, in the present study, there was no difference in the frequency of patients with ST-segment depression in the inferior leads between patients with and without ST-segment depression in the lateral chest leads.…”

“…Patients with ST-segment depression in the inferior leads in anterior wall AMI have been shown to have a higher incidence of proximal LAD occlusion, 15,18,20,21 a larger infarct size, 4,8,12,13,19 and a poorer prognosis. 6,8,12,19 Therefore, the frequency of patients with ST-segment depression in the inferior leads could affect our results.…”