Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate
Tien-En Chen1, Ping-Han Lo, Tsai-Chung Li
1Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) showing reciprocal electrocardiographic changes experienced worse hemodynamic status and higher in-hospital mortality. These reciprocal changes are an independent predictor of mortality in STEMI patients undergoing immediate intervention.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Diagnostics
Background:
- Reciprocal electrocardiographic changes are common in ST-segment elevation myocardial infarction (STEMI).
- The prognostic value of these changes in patients undergoing immediate invasive intervention remains unclear.
Purpose of the Study:
- To investigate the prognostic significance of reciprocal electrocardiographic changes in patients with acute STEMI undergoing immediate invasive intervention.
Main Methods:
- Retrospective analysis of 165 consecutive STEMI patients receiving immediate invasive intervention.
- Patients were categorized into two groups based on the presence (Group I, n=100) or absence (Group II, n=65) of reciprocal changes on their initial electrocardiogram.
Main Results:
- Group I patients exhibited higher rates of anterolateral and inferior STEMI, lower blood pressures, and increased instances of ventricular tachycardia/fibrillation and cardiopulmonary resuscitation.
- Peak troponin I levels were higher, and intra-aortic balloon pump support was more frequently required in Group I.
- Reciprocal changes were identified as an independent predictor of in-hospital mortality (OR, 9.553; P = .037), with Group I patients having worse actuarial freedom from all-cause mortality.
Conclusions:
- STEMI patients with reciprocal electrocardiographic changes demonstrate a more unstable hemodynamic status and poorer clinical outcomes.
- Reciprocal changes are associated with increased in-hospital mortality and worse long-term survival.
- Further prospective research with larger cohorts is warranted to confirm these findings.
Purposes:
Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention.
Basic Procedure:
We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65).
Main Findings:
Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I (P = .046).
Principal Conclusions:
The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.
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