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Reciprocal ST-Segment Changes in Myocardial Infarction: Ischemia at Distance Versus Mirror Reflection of
Gaurang Nandkishor Vaidya1, Steve Antoine1, Syed Haider Imam2
1Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.
The American Journal of the Medical Sciences
|February 7, 2018
Summary
Reciprocal ST-depression on ECGs in ST-elevation myocardial infarction (STEMI) does not predict collateral circulation. These ECG changes may indicate subendocardial ischemia or electrical phenomena, especially in patients presenting later.
Area of Science:
- Cardiology
- Medical Imaging
- Electrocardiography
Background:
- Reciprocal ST-depression in ST-elevation myocardial infarction (STEMI) ECGs can stem from collateral circulation or electrical phenomena.
- The predictive value of these reciprocal changes for collateral circulation remains unclear.
Purpose of the Study:
- To determine if reciprocal ECG changes predict collateral circulation to the infarcted area in STEMI patients.
- To differentiate between ischemic and electrical origins of reciprocal ST-depression.
Main Methods:
- Retrospective review of ECG and coronary angiography data from 53 STEMI patients.
- Independent expert analysis of ECG and angiography results, blinded to each other's findings.
Main Results:
- Reciprocal changes (RC) were present in 77% of patients; collateral vessels were found in 26%.
- No significant correlation was found between RC presence/depth and collateral circulation (P=0.384, P=0.195).
- Resolution of RC after percutaneous coronary intervention (PCI) occurred in 84% of patients without collaterals (P=0.036). Patients without RC presented significantly later (P=0.004).
Conclusions:
- Reciprocal changes on ECG lack predictive value for collateral circulation in STEMI.
- RC were less frequent in patients presenting late, suggesting time-related resolution.
- Reciprocal ST-depression likely represents subendocardial ischemia or an electrical phenomenon, not distant ischemia due to poor collateral flow.
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