Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression

  • Jaya Suganti Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan
  • Abdullah Afif Siregar Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan
  • Harris Hasan Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan

Abstract

Background: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.
Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.
Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).
Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.

Downloads

Download data is not yet available.

References

1. Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J. 2003;79:490–504.

2. Ferguson DW, Pandian N, Kioschos JM, et al. Angiographic evidence that reciprocal ST-segment depression during acute myocardial infarction does not indicate remote ischemia: Analysis of 23 patients. The American Journal of Cardiology. 1984;53(1):55-62.

3. Surawaciz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric. 6th ed. Philadelphia: Saunders Elsevier; 2008.

4. Sato H, Kodama K, Masuyama T, et al. Right coronary occlusion: Its role in the mechanism of precordial ST segment depression. Journal of American College of Cardiology. 1989;14:297-302.

5. Berger PB, Ryan TJ. Inferior myocardial infarction: High-risk subgroups. Circulation. 1990;81:401-11.

6. Jennings K, Reid DS, Julian DG. “Reciprocal” depression of ST segment in acute myocardial infarction. British Medical Journal. 1983;287:634-7.

7. Gelman JS, Saltrups A. Precordial ST depression in patients with inferior infarctions: Clinical implications. British Heart Journal. 1982;48:560-5.

8. Herlitz J, Hjalmarson H. Occurrence of Anterior ST depression in Inferior Myocardial Infarction and relation to clinical outcome. Clinical Cardiology. 1987;10:529-34.

9. Rude RE, Croft CH, Willerson JT. “Reciprocal” anterior ST depression early in the course of transmural inferior myocardial infarction: An ECG finding of uncertain clinical significance. International Journal of Cardiology. 1983;4:80–5.

10. Shah PK, Pichler M, Berman DS, et al. Noninvasive identification of a high-risk subset of patients with acute inferior myocardial infarction. American Journal of Cardiology. 1980;46:915-21.

11. Pichler M, Shah PK, Peter T, et al. Wall motion abnormalities and electrocardiographic changes in acute transmural myocardial infarction: implications of reciprocal ST segment depression. American Heart Journal. 1983;106:1003-8.

12. Cannon RO. Ischemia at a distance-So close yet so far. Journal of American College of Cardiology. 1985;6(1):46-8.

13. Mirvis DM. Physiological bases for anterior ST segment depression in patients with acute inferior wall myocardial infarction. American Heart Journal. 1988;116(5):1038-322.

14. Becker RC, Alpert JS. Electrocardiographic ST segment depression in coronary heart disease. American Heart Journal. 1988;115:862–8.

15. Brymer JF, Khaja F, Marzilli M, et al. “Ischemia at a distance” during intermittent coronary occlusion: a coronary anatomic explanation. Journal of American College of Cardiology. 1985;6:41-5.

16. Blumgart HL, Schlesinger MJ, Davis D. Studies on the relation of the clinical manifestations of angina pectoris, coronary thrombosis and myocardial infarction to the pathologic findings. American Heart Journal. 1940;19:1-91.

17. Salcedo JR, Baird MG, Chambers J, Beanlands D. Significance of reciprocal ST segment depression in anterior precordial leads in acute inferior myocardial infarction: Concomitant left anterior descending coronary artery disease? The American Journal of Cardiology. 1981;48(6):1003-8.

18. Roubin GS, Shen WF, Nicholson M, et al. Anterolateral ST segment depression in acute inferior myocardial infarction: Angiographic and clinical implications. American Heart Journal. 1984;107:1177-82.

19. Chaitman BR, Waters DD, Corbara F, Bourassa MG. Prediction of multivessel disease after inferior myocardial infarction. Circulation. 1978;57(6):1085-90.

20. Gibelin P, Gilles B, Guarino L, Morand P. Reciprocal ST segment changes in acute inferior myocardial infarction: Clinical, haemodynamic and angiographic implications. European Heart Journal. 1986;7:133-9.

21. Knour M. Significance of Reciprocal ST Segment Depression in ST Elevation Myocardial Infarction. JACC: Cardiovascular Intervention 2015;8 Suppl 5:15 (Abstract).

22. El Atroush H, Effat H, Shehata M, Emara H. Reciprocal ST segment changes in acute inferior myocardial infarction: Clinical, hemodynamic, and angiographic implications. Egyptian Heart Journal. 2012;64:97-103.

23. Gibson RS, Crampton RS, Watson DD, et al. Precordial ST segmen depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlation. Circulation. 1982;66:732-41.
Published
2017-04-18
Views & Downloads
Abstract views: 980   
PDF downloads: 455    HTML downloads: 103   
How to Cite
Suganti, J., Siregar, A., & Hasan, H. (2017). Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression. Indonesian Journal of Cardiology, 37(4), 180-9. https://doi.org/10.30701/ijc.v37i4.582
Section
Clinical Research