ST segment depression in acute anterior myocardial infarction

We initiated a retrospective study to determine whether ST segment depression seen in inferior leads (II, III, and aVF) during acute anterior myocardial infarction (MI) is a reciprocal change or an independent sign of ischemia of additional myocardium. We selected 20 patients with anterior MI and attempted to compare findings of subsequent cardiac catheterization and the clinical course of 14 patients with ST segment depression (group A) and six without ST segment depression (group B). Patients in group A had a higher prevalence of right coronary artery disease (13 vs 0, P less than .01), multivessel disease (14 vs two, P less than .01), inferior wall motion abnormalities (seven vs 0, P less than .01), and ejection fraction of less than .50 (ten vs two, P greater than .05) than those in group B. A greater number of patients in group A had serious in-hospital and follow-up complications (12 vs two, P less than .05). We conclude that ST depression in leads II, III and aVF during acute anterior MI is not "reciprocal change" but a high-risk indicator.