Key result
Precordial ST-segment depression in acute inferior myocardial infarction was associated with a significantly higher Gensini score of coronary artery stenosis compared to no ST-segment depression (56.3 vs 27.5, p<0.001).
Why the study?
Does precordial ST-segment depression in acute inferior myocardial infarction indicate more severe coronary artery disease and larger infarct size?
Observational (n=44)
No
Does precordial ST-segment depression in acute inferior myocardial infarction indicate more severe coronary artery disease and larger infarct size?
Absolute Event Rate: 56.3% vs 27.5%
p-value: p=<0.001
Precordial ST-segment depression in acute inferior myocardial infarction is associated with a higher Gensini score, indicating more advanced atherosclerosis in both infarct-related and non-related arteries and a larger infarct size.
May identify inferior MI patients with more severe CAD; leaves open whether ECG findings should influence acute management.
To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, we compared the Gensini score of coronary artery stenosis between 2 groups of patients with and without precordial ST-segment depression. Group I consisted of 28 patients who showed ST-segment depression on admission (greater than or equal to 1 mm in V2-V6) and Group II (n = 16) those without ST-segment depression (less than 1 mm). The Gensini score of the coronary arteries (56 +/- 29 vs. 28 +/- 18; p less than 0.001), the partial score of the infarction-related artery (29 +/- 16 vs. 17 +/- 11; p less than 0.01) and of the infarction-nonrelated artery (27 +/- 24 vs. 11 +/- 12; p less than 0.02) were significantly higher in Group I than in Group II. The Killip score (greater than or equal to II) (34% vs. 6%; p less than 0.05), frequency of arrhythmias (75% vs. 38%; p less than 0.02) and peak CK value (3,676 +/- 2,290 vs. 1,818 +/- 1,153 IU/L; p less than 0.005) were higher in Group I than in Group II. Four patients in Group I died following admission, while no patient died in Group II (N.S.). Autopsy findings from the 4 Group I patients revealed fresh extensive inferior infarction and healed diffuse subendocardial infarction which could not be predicted from electrocardiograms. All patients who survived the acute stage performed treadmill exercise testing and 22 patients underwent exercise thallium-201 single photon emission computer tomography (SPECT). On treadmill exercise test, there was no significant difference between the 2 groups in the frequency of angina pectoris and ST-segment depression. On SPECT, the perfusion defect area under 55% of maximum uptake at the redistribution phase was 45.8 +/- 19.6 cm2 in Group I (n = 14) and 34.7 +/- 21.3 cm2 in Group II (n = 8; N.S.). In conclusion, precordial ST-segment depression in acute inferior myocardial infarction suggested advanced atherosclerosis in both the infarction-related and nonrelated coronary arteries, indicating a larger infarct size.
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Takayanagi et al. (1992) conducted an observational in Acute inferior myocardial infarction (n=44). Precordial ST-segment depression vs. No precordial ST-segment depression was evaluated on Gensini score of coronary artery stenosis (p=<0.001). Precordial ST-segment depression in acute inferior myocardial infarction was associated with a significantly higher Gensini score of coronary artery stenosis compared to no ST-segment depression (56.3 vs 27.5, p<0.001).
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