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Background: Reciprocal ST-depression in ST-elevation myocardial infarction(STEMI) represent either extensive primary ischemia, ischemia at a distance through collaterals diverting blood to the infarcted region or just a benign electrical phenomenon mirroring ST-elevation.
Hypothesis: Test if reciprocal changes (RC) can predict underlying collaterals and identify if RC result through ‘steal’ by collaterals.
Methods: EKG and angiography of 53 STEMI patients admitted in Upstate Medical University in 2014 were reviewed.
Results: RC were present in 41 patients(77%) and on angiography (PCI), 14 patients(26%) exhibited collaterals to the ischemic areas. No correlation was found between the presence of RC and collaterals (p=0.384) or between the depth of reciprocal ST-depression and degree of collaterals(p=0.195). Leads demonstrating reciprocal ST-depression were similar irrespective of the collaterals (figure). Conversely, 84% of patients lacking collaterals exhibited resolution of RC after successful PCI (50% in the other group, p=0.036), suggesting that the ST-depression in these patients were directly caused by the culprit vessel which resolved after reperfusion. Patients with RC had higher peak troponin T(7.47 vs 2.90 ng/ml, p=0.04) indicating larger ischemic injury.
Conclusions: Reciprocal ST-depression play no role in predicting underlying collaterals. They may represent extensive subendocardial ischemia from the primary coronary event or simply a mirror electrical phenomenon.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-338
- 2017 American College of Cardiology Foundation