Key result
Specific ST-depression patterns on admission ECG are linked to multivessel disease in anterior AMI.
Why the study?
The correlation between admission ECG findings and coronary angiography for predicting culprit vessel or multivessel disease in acute anterior or anterior-inferior MI was unclear.
Observational (n=101)
ST depression in aVL/V6 associated with multivessel disease in anterior AMI; leaves open whether ECG improves culprit prediction in practice.
BACKGROUND: Our aim was to investigate the correlation between admission ECG and coronary angiography findings in terms of predicting the culprit vessel responsible for the infarct or multivessel disease in acute anterior or anterior-inferior myocardial infarction (AMI). METHODS: We investigated 101 patients with a diagnosis of anterior AMI with or without ST-segment elevation or ST-segment depression in at least two leads in DII, III, aVF. The patients were classified as those with vessel involvement in the left anterior descending (LAD) coronary artery and patients with multivessel disease. Vessel involvement in LAD + circumflex artery (Cx) or LAD + right coronary artery (RCA) or LAD + Cx + RCA were considered as multivessel disease. Thus, (a) anterior AMI patients with reciprocal changes in inferior leads, (b) anterior AMI patients with inferior elevations, (c) all anterior AMI patients according to the ST-segment changes in the inferior region were analyzed according to the presence of LAD or multivessel involvement. RESULTS: Presence of ST-segment depression in aVL and V6 was significantly correlated with the presence of multivessel disease in anterior AMI patients with reciprocal changes in the inferior leads (P = 0.005 and P = 0.003, respectively). No statistically significant difference between the leads were detected in terms of ST-segment elevation in predicting vessel involvement in the two groups of anterior AMI patients with inferior elevations. When all the patients with anterior AMI were analyzed, the presence of ST-segment depression in leads aVL, V4, V5 and V6 were significantly associated with the presence of multivessel disease (P = 0.035, P = 0.010, P = 0.011, P = 0.001, respectively). CONCLUSIONS: The presence of ST-segment depression in anterolateral leads in the admission ECG of anterior AMI patients with reciprocal changes in inferior leads was associated with multivessel disease.
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Kürüm et al. (2002) conducted an observational in Acute anterior or anterior-inferior myocardial infarction (n=101). ST-segment depression in anterolateral leads (aVL, V4, V5, V6) on admission ECG vs. Absence of ST-segment depression in these leads was evaluated on Presence of multivessel disease on coronary angiography. The presence of ST-segment depression in leads aVL, V4, V5, and V6 on admission ECG was significantly associated with multivessel disease in patients with anterior AMI (P≤0.035).
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