Author + information
- Received October 19, 1989
- Revision received July 16, 1990
- Accepted August 26, 1990
- Published online December 1, 1990.
- Eric R Bates, MD, FACC∗∗,
- Peter M Clemmensen, MD†,
- Robert M Califf, MD, FACC†,
- Laura E Gorman, RN∗,
- Lynne G Aronson, BS†,
- Barry S George, MD‡,
- Dean J Kereiakes, MD, FACC§,
- Eric J Topol, MD, FACC∗,
- TheThrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group∥
- ↵∗Address for reprints: Eric R. Bates, MD, Division of Cardiology, University of Michigan Hospitals, 1500 East Medical Center Drive, AGH BIF245, Ann Arbor, Michigan 48109-0022.
The impact of associated precordial ST segment depression in inferior myocardial infarction on angiographic and clinical outcomes after thrombolytic therapy and selective coronary angioplasty was studied in 583 patients with acute myocardial infarction. Anterior infarction (Group I), inferior infarction with precordial ST segment depression (Group II) and inferior infarction without precordial ST segment depression (Group III) were present in 289, 135 and 159 patients, respectively.
Precordial ST segment depression was more frequent in circumflex than right coronary infarct-retated arteries (44 [71%] of 62 versus 91 [40%] of 230; p = 0.000). Although acute patency rates were not statistically different, there was a trend toward different patency rates at day 7 (Group I 88%, Group II 84%, Group III 80%; p = 0.089) partly because of insignificantly higher reocclusion rates in inferior infarction without precordial ST segment depression (Group I 11%, Group II 10%, Group III 18%, p = 0.104).
Infarct zone regional wall motion (standard deviations/ chord) in inferior infarction was lower with precordial ST segment depression, both acutely (Group I −2.8 ± 0.9, Group II −2.5 ± 1.2, Group III 2.0 ± 1.1; p = 0.000) and at day 7 (Group I −2.2 ± 1.1, Group II −2.3 ± 1.1, Group III −1.9 ± 1.3; p = 0.011). Precordial ST segment depression was associated with a lower ejection fraction in inferior infarction both acutely (Group 147 ± 11%, Group II 53 ± 11%, Group III 58 ± 9%; p = 0.000) and at day 7 (Group I 49 ± 12%, Group II 53 ± 10%, Group III 58 ± 8%; p = 0.000).
Complication rates tended to be higher in inferior infarction when precordial ST segment depression was present. Mortality rates for Groups I, II and III were 8%, 6% and 5%, respectively. These results suggest that precordial ST segment depression in inferior infarction predicts a worse ventriculographic and clinical outcome despite reperfusion therapy.
↵∥ A complete list of the TAMI participating centers and investigators appears in J Am Coll Cardiol 1987;10(suppl B):65B–74B.
☆ This study was presented in part at the 61st Scientific Session of the American Heart Association, Washington, DC, November 1988. It was supported in part by Genentech, South San Francisco, California.
- Received October 19, 1989.
- Revision received July 16, 1990.
- Accepted August 26, 1990.