Patients with suspected myocardial infarction who present with ST depression

Lee, H.S; Cross, Stephen; Jennings, K.; Rawles, John

doi:10.1016/0140-6736(93)92186-w

Cited by 76 publications

(27 citation statements)

References 20 publications

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“…ST depression in leads V1 through V3 or DI to AVL appears to correspond to mere mirroring, often from circumflex artery occlusion (15). Lee et al found a 1-year mortality rate of 31% in a cohort of patients who were seen in 1990 with ST-segment depression in whom AMI was confirmed (16). In a study of more than 1000 patients with inferior infarction, the presence of maximum ST depression in leads V1 through V3 indicated a much lower probability of proximal right coronary artery occlusion than its absence or than a maximum ST depression in leads V4 through V6.…”

Section: Discussionmentioning

confidence: 99%

Importance of Reciprocal ST Segment Depression in the Extensive Coronary Artery Disease

Karapınar¹,

Yanartaş

Karaveli̇oğlu³

et al. 2010

ELECTRON J GEN MED

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Section: Discussionmentioning

confidence: 99%

Importance of Reciprocal ST Segment Depression in the Extensive Coronary Artery Disease

Karapınar¹,

Yanartaş

Karaveli̇oğlu³

et al. 2010

ELECTRON J GEN MED

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“…Not surprisingly, ST-segment elevation in lead aVR was also related to ST-segment depression in other leads, a finding with well-known adverse prognostic implications. [2][3][4][5][6][7][8][9][10][11] Because lead aVR points at Ϫ150 degrees in the frontal plane (or inverted lead aVR at ϩ30 degrees), ST-segment elevation in this lead was especially associated with lateral or to a minor extent inferior ST-segment depression. However, STsegment elevation in lead aVR was superior to ST-segment depression elsewhere in predicting the risk of death even after adjusting for the location of ST-segment depression, which had incremental prognostic value in our previous study.…”

Section: Discussionmentioning

confidence: 99%

“…1 The ECG has been extensively used for this purpose, and ST-segment depression on admission is now recognized as one of the strongest predictors of an adverse outcome. [2][3][4][5][6][7][8][9][10][11] In these patients, ST-segment depression has also been related to the presence of extensive coronary artery disease 3,6,8,12 and to a greater benefit of an early invasive therapeutic approach. 12,13 Lead aVR, whose positive pole is oriented to the right upper side of the heart, usually gives a mirror image of the leads oriented leftward, for which reason it is often ignored.…”

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confidence: 99%

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2003

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Background-ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown. Methods and Results-We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V 1 . The rates of in-hospital death in patients without (nϭ525) and with 0.05 to 0.1 mV (nϭ116) or Ն0.1 mV (nϭ134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (PϽ0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (PϽ0.001). Conclusions-Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.

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“…Patients with suspected myocardial infarction who present with ST depression have previously been reported to have a high mortality [15].…”

Section: Discussionmentioning

confidence: 99%

Mortality and Risk Indicators for Death during Five Years after Acute Myocardial Infarction among Patients With and Without ST Elevation on Admission Electrocardiogram

Herlitz

Karlson²,

Bång³

et al. 1997

Cardiology

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We related observations in the electrocardiogram (ECG) on admission to hospital among consecutive patients hospitalized in one single hospital with acute myocardial infarction (AMI) and related the prognosis during the following 5 years to these observations. Results: Of 863 patients, 63% had ECG signs of myocardial ischemia, but only 41% had ST elevation on ED admission. Patients with ST elevation had a 5-year mortality of 44% as compared with 58% in patients without ST elevation (p < 0.001). Patients with the highest mortality were those with a pathologic ECG including signs of previous AMI, bundle branch block and pacemaker ECG, but with no ECG sign of acute ischemia. Patients with the lowest mortality were those with a nonpathologic ECG on admission. Conclusion: Among consecutive patients hospitalized with AMI, less than half had ST elevation on admission to hospital. These patients had a lower mortality during 5 years of follow-up than patients without ST elevation.

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Patients with suspected myocardial infarction who present with ST depression

Cited by 76 publications

References 20 publications

Importance of Reciprocal ST Segment Depression in the Extensive Coronary Artery Disease

Importance of Reciprocal ST Segment Depression in the Extensive Coronary Artery Disease

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

Mortality and Risk Indicators for Death during Five Years after Acute Myocardial Infarction among Patients With and Without ST Elevation on Admission Electrocardiogram

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