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"Tombstoning" of ST segment in acute myocardial infarction -- effect on clinical course

Piotr Kukla1, Dariusz Dudek, Kazimierz Szczuka

  • 1Oddział Wewnetrzny, Szpital Specjalistyczny im H. Klimontowicza, ul. Wegierska 21, 38-300 Gorlice. kukla_piotr@poczta.onet.pl

Kardiologia Polska
|April 4, 2006
PubMed

Insights

Tombstoning ST segment (TOMB-ST) in ST-elevation myocardial infarction (STEMI) affects clinical outcomes. This specific ST elevation shape is linked to higher mortality, heart failure, and ventricular fibrillation rates in STEMI patients.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Medical Diagnostics

Background:

  • Limited research exists on the prognostic impact of ST segment elevation shape in ST-elevation myocardial infarction (STEMI).
  • Existing studies primarily focus on ST segment elevation amplitude rather than morphology.
  • Understanding ST elevation patterns can refine risk stratification in STEMI patients.

Purpose of the Study:

  • To determine the incidence of "tombstoning" ST segment (TOMB-ST) in STEMI patients.
  • To evaluate the association between TOMB-ST and clinical outcomes, including in-hospital complications and mortality.

Main Methods:

  • Retrospective analysis of 207 consecutive STEMI patients hospitalized between 2000 and 2002.
  • Assessment of ST segment morphology, specifically "tombstoning" (TOMB-ST), upon admission.
  • Correlation of TOMB-ST with in-hospital complication rates, mortality, and left ventricular ejection fraction.

Main Results:

  • "Tombstoning" ST segment (TOMB-ST) was identified in 26.1% of STEMI patients, more frequently in anterior MI.
  • Patients with TOMB-ST exhibited significantly higher mortality (38.2% vs. 9.9%), heart failure (45.6% vs. 28.3%), ventricular fibrillation (18.1% vs. 6.4%), and lower LVEF (40.9% vs. 48.6%).
  • In patients without TOMB-ST, elevated ST segment deviation sum (SigmaST >20 mm) correlated with significantly different mortality rates.

Conclusions:

  • "Tombstoning" ST segment (TOMB-ST) is a distinct morphological pattern in STEMI associated with adverse clinical outcomes.
  • TOMB-ST independently predicts increased mortality, heart failure, and ventricular fibrillation in STEMI patients.
  • The prognostic significance of total ST segment deviation amplitude differs between STEMI patients with and without TOMB-ST.
Abstract

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