Reciprocal ST depression in acute myocardial infarction

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Interventional Cardiology

Background:

• ST segment depression in leads remote from ST elevation during acute myocardial infarction (AMI) has unclear origins.
• Potential causes include benign electrical phenomena, distant ischemia, or extensive myocardial damage.

Purpose of the Study:

• To investigate whether reciprocal ST depression during AMI predicts concomitant coronary artery disease (CAD).
• To determine if reciprocal ST depression can predict the location and severity of CAD in patients with first transmural myocardial infarction.

Main Methods:

• Eighty-four young survivors (<55 years) of first transmural myocardial infarction were studied.
• Exercise tests were performed six weeks post-infarction, and coronary angiography was done a mean of three months later.
• Reciprocal ST depression (≥1 mm) during the acute phase was assessed in relation to exercise test findings and angiographic evidence of CAD.

Main Results:

• Reciprocal ST depression occurred in 75% of inferior and 58% of anterior infarcts.
• In inferior infarcts, reciprocal ST depression did not predict left anterior descending artery disease.
• In anterior infarcts, reciprocal ST depression did not predict right coronary artery disease.

Conclusions:

• Reciprocal ST depression during acute myocardial infarction is not a reliable predictor of concomitant coronary artery disease in the artery supplying the reciprocal territory.
• These findings suggest that reciprocal ST depression should not be used to infer the presence or location of significant CAD.