Prognostic significance of precordial ST segment depression on admission electrocardiogram in patients with inferior wall myocardial infarction

Abstract

The risk of mortality is higher in patients with an inferior myocardial infarction and maximal ST segment depression in precordial leads V4 to V6 versus precordial leads V1 to V3 on the admission ECG.

Site of Transmural Late Gadolinium Enhancement on the Cardiac MRI Coincides With the ECG Leads Exhibiting Terminal QRS Distortion in Patients With ST-Elevation Myocardial Infarctions

“…Terminal QRS distortion on the admission ECG, as originally described by Birnbaum,1) is associated with larger infarcts and increased mortality in patients undergoing reperfusion therapy for STEMIs. The mechanisms of the terminal QRS distortion are explained by a prolongation of the electrical conduction in the Purkinje fibers in the ischemic region.…”

“…R ecently, it has been reported that large infarcts are associated with terminal QRS-distortion in patients with ST-elevation myocardial infarctions (STEMIs), [1][2][3][4] and that the ECG pattern of the distortion of the terminal portion of the QRS complex is an independent predictor of the prognosis in STEMI patients, and has a better correlation to the infarct size than the magnitude of the ST segment elevation.…”

“…QRSdistortion in the ECG on admission represents severe transmural infarction in the LGE using CMR, which represents large infarcts in STEMI patients. (Int Heart J 2012; 53: 270-275) Key words: Acute myocardial infarction (AMI), Magnetic resonance imaging, Electrocardiography, Electrical damage, Ischemic heart disease, Localization of ventricular injury R ecently, it has been reported that large infarcts are associated with terminal QRS-distortion in patients with ST-elevation myocardial infarctions (STEMIs), [1][2][3][4] and that the ECG pattern of the distortion of the terminal portion of the QRS complex is an independent predictor of the prognosis in STEMI patients, and has a better correlation to the infarct size than the magnitude of the ST segment elevation.5) The evaluation of the infarct size and morphology of the late gadolinium enhancement (LGE) on cardiac MRI (CMR) has been well validated and is currently considered the clinical gold standard for a viability assessment. 6,7) However, it remains to be elucidated whether the LGE findings correlate with the QRS-distortion.…”

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

“…[15][16][17][18][19][20][21][22][23][24][25][26] According to Peterson et al 25 , there is marginal correlation of magnitude of precordial depression of ST segment with the magnitude of elevation of ST segment in inferior AMI. Contrary to the above narrated studies, we observed that multivessel disease was more common in patients having depression of ST segment in leads V4-6 (83.6%) compared to 56.8% in Group I (V1-3) with acute inferior MI thus indicating the association of depression of ST segment in anterior leads with CAD.…”

Electrocardiographic manifestations: acute inferior wall myocardial infarction

“…It is clinically relevant because these patients have the best overall outcome of all sub-groups of IWMI. In addition, these patients have less myocardial damage as measured by lower peak CK values, and lower rates of heart failure, cardiogenic shock, and dysrhythmias (2,8). Peterson et al report in-hospital mortality rates of 3.2% in those patients without reciprocal changes, and 4.7% with reciprocal changes.…”