[Heterozonal electrocardiographic changes in ST-elevation myocardial infarction]
Enrico Onnis1, Ramona Stara, Christian Cadeddu
1Cattedra e Divisione di Cardiologia, Università degli Studi, Cagliari. eonnis@tiscali.it
Giornale Italiano Di Cardiologia (2006)
|April 4, 2007
Summary
ST-segment depression in remote leads during ST-elevation myocardial infarction (STEMI) is common and linked to microvascular dysfunction risk factors. This finding suggests heterozonal ischemia independent of coronary artery blockages.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Diagnostics
Background:
- ST-segment depression in heterozonal leads (remote ST) in ST-elevation myocardial infarction (STEMI) patients is associated with worse prognosis.
- The incidence and associated risk factors of remote ST in a first STEMI population require further investigation.
Purpose of the Study:
- To determine the incidence of remote ST in patients experiencing their first STEMI.
- To identify risk factors associated with the presence of remote ST in this patient group.
Main Methods:
- Retrospective analysis of 350 patients with a first STEMI, excluding 139 due to unavailable coronary anatomy data.
- Significant remote ST defined as > 0.1 mV depression at 60 ms from the J point in at least two electrocardiographic leads.
Main Results:
- Remote ST was observed in 117 patients (group I) versus 94 patients without remote ST (group II).
- Group I showed more heterozonal wall motion abnormalities (32% vs. 18%), higher smoking incidence (56% vs. 33%), and lower statin use (6% vs. 14%).
- Patients with remote ST had elevated total cholesterol and LDL cholesterol levels.
Conclusions:
- Remote ST is a frequent finding in STEMI patients, indicating potential heterozonal ischemia unrelated to non-infarct-related artery stenosis.
- Remote ST is associated with risk factors for microcirculatory dysfunction, including smoking and adverse lipid profiles, and reduced use of protective statins.
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