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Correlation of reciprocal ST-segment depression after acute myocardial infarction with coronary angiographic findings
M Kyriakidis1, A Antonopoulos, J Barbetseas
1Cardiac Department, Hippokration Hospital, University of Athens, Greece.
Insights
Electrocardiographic ST-segment depression opposite acute myocardial infarction indicates significant ischemia. Deeper, longer ST depression correlates with more severe coronary artery disease and impaired left ventricular function.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Acute myocardial infarction (AMI) diagnosis often relies on electrocardiography (ECG).
- The prognostic significance of "mirror image" ST-segment changes in AMI requires further elucidation.
Purpose of the Study:
- To assess the clinical significance of electrocardiographic ST-segment depression opposite the infarct area in patients with acute myocardial infarction.
- To correlate these ECG findings with the extent of coronary artery disease and left ventricular function.
Main Methods:
- Studied 266 patients with acute myocardial infarction, categorizing them by infarct location (anterior vs. inferior).
- Assessed coronary artery stenosis using the Gensini index and evaluated ST-segment depression depth and duration on ECG.
- Correlated ECG findings with coronary artery stenosis severity and left ventricular ejection fraction.
Main Results:
- Patients with severe coronary artery stenosis (>85%) showed significantly greater depth and duration of ST-segment depression compared to those with less stenosis.
- Subgroups with severe stenosis exhibited lower left ventricular ejection fractions.
- Strong positive correlations were found between ST-segment depression and the Gensini index for both anterior and inferior infarcts.
Conclusions:
- Increased depth and duration of ST-segment depression opposite the infarct are indicative of myocardial ischemia.
- These ECG findings are directly related to the extent of coronary artery disease, degree of stenosis in supplying vessels, and left ventricular dysfunction.
Abstract:
We studied 266 consecutive patients with acute myocardial infarction to assess the significance of electrocardiographic "mirror images". Ninety-four (group A) had anterior wall and 132 (group B) had inferior wall infarction. Thirty-one group A patients had stenosis of the right coronary artery greater than 85% in diameter (subgroup A1), and 63 either had a normal right coronary artery or less than 85% stenosis (subgroup A2). Of group B patients 62 had greater than 85% stenosis of the left anterior descending (subgroup B1) and 70 had a left anterior descending or less than 85% stenosis (subgroup B2). ST-segment depression was significantly greater in depth and duration in subgroup A1 than A2 (p = 0.02) and in subgroup B1 than B2 (p = 0.02, p = 0.01, respectively). Left ventricular ejection fraction was lower in subgroup A1 than A2 (p less than 0.001) and in B1 than B2 (p less than 0.001). There was a strongly positive correlation between depth and duration of ST-segment depression and the Gensini index (r = 0.78, 0.84) for anterior and inferior infarction, respectively. In conclusion, increased depth and duration of ST-segment depression opposite the infarct are indicative of ischemia, and are related to the extent of coronary artery disease, the degree of stenosis of the vessels supplying the opposite wall and of left ventricular dysfunction.