Author + information
- Received January 23, 1984
- Revision received March 28, 1984
- Accepted April 6, 1984
- Published online September 1, 1984.
- ↵*Address for reprints: Bodh I. Jugdutt, MBChB, 6-112, Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3.
This study was performed to determine whether inferior ST segment depression during early stages of acute transmural anterior myocardial infarction identifies patients with multivessel coronary artery disease and additional inferior ischemia. Coronary and left ventricular angiography were performed within 3.4 months in 33 patients with acute transmural anterior infarction. Initial electrocardiograms, 2 to 5 hours after onset of chest pain, revealed significant ST segment depression (≥ 0.1 mV) in at least two of leads II, III and aVF in 15 patients (45%) (group B); in 18 patients (group A) this finding was absent.
Compared with group A, patients in group B had greater anterior ST elevation (1.2 versus 0.7 mV, p < 0.025); higher serum peak creatine kinase (2,475 versus 1,147 IU/liter, p < 0.005); higher KUlip scores (2.1 versus 1.3, p < 0.001); more in-hospital complications (60 versus 17%, p < 0.05); lower mean left ventricular ejection fraction (34 versus 55%, p < 0.001); more frequent regional left ventricular dysfunction in anterolateral (91 versus 44%, p < 0.05), posterolateral (36 versus 0%, p < 0.05) and inferior (100 versus 6%, p < 0.005) regions; greater wall motion abnormality scores (10.0 versus 5.5, p < 0.005); higher frequency of concomitant left circumflex or right coronary artery disease, or both (80 versus 28%, p < 0.01); more frequent postinfarction angina (100 versus 39%, p < 0.001) and lower New York Heart Association functional classification scores (1.7 versus 2.4, p < 0.05) at 6 month follow-up. The time course of inferior ST depression differed from that of anterior ST elevation. Thus, inferior ST depression was maximal in the first 48 hours and decreased (p < 0.05) thereafter. In contrast, ST elevation in leads V1to V6and I appeared to decrease (p = NS) between days 4 and 7. However, inferior ST depression “mirrored” ST elevation in lead aVL, which also decreased (p < 0.05) after 48 hours.
Thus, inferior ST depression during anterior infarction is associated with more expensive infarction, greater morbidity and higher frequency of multivessel coronary disease. Such inferior ST depression might reflect not only “reciprocal change,” but also ischemia in adjacent lateral and remote inferior regions.
- Received January 23, 1984.
- Revision received March 28, 1984.
- Accepted April 6, 1984.
- American College of Cardiology Foundation