Exercise-induced precordial ST-segment depression in patients with acute inferior myocardial infarction. Significance of concomitant ST-segment depression in limb leads.

Tamio Nakajima; Toshio Hashimoto; Naofumi Doi; Atsuhiko Kawamoto; Shiro Uemura; Shinichi Fujimoto; Kazuhiro Dohi

doi:10.5105/jse.19.170

January 1, 1999Japanese Journal of ElectrocardiologyOpen Access

Exercise-induced precordial ST-segment depression in patients with acute inferior myocardial infarction. Significance of concomitant ST-segment depression in limb leads.

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Why the study?

Does exercise-induced ST-segment depression in limb leads predict significant coronary stenosis better than precordial ST-segment depression in patients with acute inferior myocardial infarction?

Structured PICO

Does exercise-induced ST-segment depression in limb leads predict significant coronary stenosis better than precordial ST-segment depression in patients with acute inferior myocardial infarction?

P

Population

45 patients with first acute inferior myocardial infarction (culprit lesion in the right coronary artery) who underwent cardiac catheterization in the acute and chronic phases, and predischarge treadmill exercise testing. Mean age 62, 80% male. Excluded: bundle branch block, no treadmill test performed, and restenosis in the chronic phase after successful acute percutaneous coronary intervention.

I

Intervention

Predischarge treadmill exercise testing (modified Bruce protocol) performed at a mean of 28±9 days after onset.

C

Comparator

Patients without significant coronary stenosis (Group I, n=27) compared to patients with significant coronary stenosis in any coronary artery (Group II, n=18).

O

Outcome

Diagnostic accuracy (sensitivity, specificity, predictive values) of exercise-induced ST-segment depression in precordial and limb leads for predicting significant coronary stenosis.surrogate

In patients with acute inferior myocardial infarction, exercise-induced ST-segment depression in limb leads is a highly specific marker for significant residual coronary stenosis, whereas precordial ST depression alone is often a false positive likely related to wall motion abnormalities.

Limitations

Different timing of treadmill testing and coronary angiography
Different timing of left ventriculography and treadmill testing
Weak correlation between ST depression and wall motion abnormality requires further study with other modalities like myocardial scintigraphy or stress echocardiography

Implication

Limb lead ST depression may enhance specificity for residual stenosis in inferior MI; leaves open prospective validation before changing exercise test interpretation.

Discussion

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Cite This Study

Nakajima et al. (1999) studied this question.

synapsesocial.com/papers/6a98181e9835657fd76c75f3 https://doi.org/10.5105/jse.19.170

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Exercise-induced precordial ST-segment depression in patients with acute inferior myocardial infarction. Significance of concomitant ST-segment depression in limb leads.

Structured PICO

Limitations

Implication

Discussion

Cite This Study

Exercise-induced precordial ST-segment depression in patients with acute inferior myocardial infarction. Significance of concomitant ST-segment depression in limb leads.

Structured PICO

Limitations

Implication

Discussion

Cite This Study

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