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Published on: February 16, 2016
Comparison of regional wall motion abnormalities in patients with occlusion myocardial infarction with and without
Alexander Bracey1, H Pendell Meyers2, Caleb Watkins1
1Department of Emergency Medicine, Albany Medical Center Hospital, Albany, NY, USA.
Insights
Regional wall motion abnormalities (RWMAs) occur similarly in acute coronary occlusion myocardial infarction (OMI) with or without STEMI criteria. Echocardiography findings correlate with ECG, even in STEMI-negative OMI cases.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Acute coronary occlusion myocardial infarction (OMI) is a critical condition requiring prompt diagnosis.
- Electrocardiogram (ECG) with STEMI criteria is a key diagnostic tool, but not all OMI cases meet these criteria.
- Regional wall motion abnormalities (RWMAs) detected by echocardiography can indicate myocardial ischemia.
Purpose of the Study:
- To compare the rates of RWMAs in patients with OMI, with and without STEMI criteria on ECG.
- To assess the correlation between RWMA location and the anatomical territory predicted by ECG in OMI patients.
- To evaluate the diagnostic utility of echocardiography in identifying OMI, particularly in STEMI-negative cases.
Main Methods:
- Retrospective review of a high-risk acute coronary syndrome (ACS) patient database.
- Comparison of RWMA rates between STEMI-positive OMI and STEMI-negative OMI groups using echocardiography.
- Analysis of the concordance between RWMA location and ECG-predicted territories.
Main Results:
- Similar rates of RWMAs were observed in STEMI-positive OMI (90%) and STEMI-negative OMI (82%) patients.
- Both OMI groups showed a higher prevalence of RWMAs compared to the No Occlusion (NOMI) group (45%).
- RWMA location correlated well with ECG findings in 92.5% of STEMI-positive OMI and 82.3% of STEMI-negative OMI patients.
Conclusions:
- ECG findings correlate with RWMA location in OMI, irrespective of STEMI criteria presence.
- Echocardiography demonstrates utility in detecting OMI even when STEMI criteria are absent on ECG.
- Further prospective studies are recommended to confirm the role of echocardiography in diagnosing STEMI-negative OMI.
Objective:
We aimed to determine whether there are similar rates of regional wall motion abnormalities (RWMAs) in patients with acute coronary occlusion myocardial infarction (OMI) with and without ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG).
Methods:
We performed a retrospective review of a database of patients at high risk for acute coronary syndrome with previously established outcomes for the presence of OMI in order to compare rates of RWMA in patients presenting with STEMI(+) OMI versus STEMI(-) OMI. Furthermore, we compared how often the RWMA aligned with the anatomical territory observed on ECG.
Results:
Among 808 patients, 551 underwent formal echocardiography, including 256 of 265 OMI patients and 295 of 543 patients with no occlusion. Of the 256 OMI patients that underwent formal echocardiography, only 105 (41.0%) met STEMI criteria. Among them, 94 of 105 (89.5%) STEMI(+) OMI patients had RWMAs compared to 124 of 151 (82.1%) STEMI(-) OMI patients (P=0.10; 95 confidence interval, -1.63% to 15.6%). Both groups had a greater prevalence of RWMA than the non-OMI group (45%). RWMA matched the anatomic territory predicted by ECG in 92.5% of STEMI(+) OMI, 82.3% of STEMI(-) OMI, and 2.9% of the no-occlusion cohort.
Conclusion:
Location of RWMAs was well-correlated with ECG findings regardless of the presence or absence of STEMI criteria. A prospective study is warranted to determine the utility of echocardiography in the detection of STEMI(-) OMI.
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