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

2017 ◽  
pp. 180-9
Author(s):  
Jaya Suganti ◽  
Abdullah Afif Siregar ◽  
Harris Hasan
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Multiple Logistic Regression Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Bivariate Analysis ◽  
P Value ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Increased Risk ◽  
Acute Inferior Myocardial Infarction

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.

scholarly journals Corelation Between Sum of Precordial ST Depression in Acute Inferior Myocardial Infarction with Stenosis Severity of Left Anterior Descending Artery

2019 ◽  
Vol 2 (1) ◽  
pp. 1-9
Author(s):  
Kartika br Karo ◽  
Andre Pasha Ketaren ◽  
Refli Hasan ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bivariate Analysis ◽  
P Value ◽  
High Grade ◽  
Inferior Myocardial Infarction ◽  
St Depression ◽  
Stenosis Severity ◽  
Ecg Criteria ◽  
High Degree ◽  
Acute Inferior Myocardial Infarction

Background : There were many studies proved that precordial ST depression in Inferior STEMI show LAD disease from angiografi, but there were also many who unproved . Altought LAD disease was not the main cause of precordial ST depression in Inferior STEMI, but there were many patients with Inferior STEMI who had high grade LAD disease. Sum of precordial ST depression is one of ECG criteria that can help us to prove it . The aim of this study in to know if there is corelation between sum of precordial ST depression with LAD disease and the severity of LAD disease in Inferior STEMI patients with precordial ST depression . Methods : We analized 60 patients inferior STEMI with precordial ST depression onset less than 24 hours that hospitalized in Haji Adam Malik General Hospital since December 2013-June 2017. Patients were divided in to 4 groups based on sum of precordial ST depression. Bivariate analysis were made to see the corelation between sum of precordial ST depression with LAD disease and severity of LAD, p value < 0.05 is statistically significant.  Result : Bivariate analysis show that there is strong corelation between sum of precordial ST depression with LAD disease (p=0.01). Sum of precordial ST depression also corelate with severity of LAD (p=0.01). There are also corelation with location of the lesion in proximal LAD and the complexity of the lesion but not statistically significant (p=0.233 and p=0.102). Analysis ROC curve  sum of precordial ST depression to LAD disease give the cut off ≥5.15 mm with sensitivity 70% and spesificity 76.2%(AUC 0,752 ,95% CI: 0,620 – 0,883 p<0,001) Conclusion : There is strong corelation between sum of precordial ST depression with high grade LAD disease. The more the sum of precordial ST depression the more posibility high degree LAD disease ( p=0.01).

CLINICAL HEMODYNAMIC STUDY OF RECIPROCAL ST SEGMENT CHANGES IN ACUTE INFERIOR MYOCARDIAL INFARCTION

2021 ◽  
pp. 29-32
Author(s):  
Mohammad Wajid Hussain ◽  
Kumar Sourav ◽  
Binay Kumar ◽  
Debarshi Jana
Keyword(s):  
Myocardial Infarction ◽  
P Value ◽  
Inferior Myocardial Infarction ◽  
Aggressive Approach ◽  
St Depression ◽  
Depression Group ◽  
St Segment ◽  
Group 2 ◽  
Acute Inferior Myocardial Infarction ◽  
Group 1

Objective: To investigate the clinical signicance of reciprocal ST segment depression on the presenting electrocardiogram in patients with acute inferior myocardial infarction. Design And Setting: A prospective, randomized, controlled single center study done in the medicine department of JLNMCH, Bhagalpur, Bihar. Subjects: Forty consecutive patients with acute inferior myocardial infarction were enrolled in this study divided into two groups, 20 patients with reciprocal ST depression (group 1) and 20 patients without such depression (group 2). Interventions: All patients were investigated with serial ECG, cardiac biomarkers, echocardiography and coronary angiography. Results: There was no signicant difference in the proportion of coronary disease risk factors in patients in group 1, versus those in group 2. Patients in group 1 had signicant higher degree ST elevation (in inf. Leads) than patients in group 2, higher levels of peak total CPK and CKMB was also seen. In addition patients in group 1 developed complication more frequently than those in group 2. Although no statistically signicant difference between the two groups was seen as regard the ejection fraction sought by echocardiography, it did show a higher incidence of mitral regurge in group 1 [14 (70%)] versus 6 (30%) in group 2 with P value of 0.01. In group 1 left ante-rior descending artery lesions was signicantly more frequent than in group 2 with P value < 0.001, also multivessel disease was signicantly more frequent in group 1. Conclusion: The signicance of reciprocal ST depression on the electrocardiogram during the course of inferior MI remains uncertain, opinion is divided as to whether it is a benign electrical phenomenon or a sign of a greater myocardial necrosis and more frequent left coronary artery dis-ease, from our study we support the latter opinion. This simple ECG nding may be used to differ-entiate high risk patients for a more aggressive approach.

scholarly journals Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations.

Circulation ◽  
1982 ◽  
Vol 66 (4) ◽  
pp. 732-741 ◽  
Author(s):  
R S Gibson ◽  
R S Crampton ◽  
D D Watson ◽  
G J Taylor ◽  
B A Carabello ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Acute Inferior Myocardial Infarction

scholarly journals Prediction of the Site of Coronary Artery Lesion in Acute Inferior Myocardial Infarction with Right Sided Precordial Lead (V4r)

1970 ◽  
Vol 4 (1) ◽  
pp. 46-52
Author(s):  
MS Alam ◽  
M Ullah ◽  
SU Ulabbi ◽  
MM Haque ◽  
R Uddin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wave Group ◽  
Precordial Lead ◽  
Inferior Myocardial Infarction ◽  
Group Iii ◽  
T Wave ◽  
Group I ◽  
St Segment ◽  
Group Ii ◽  
Acute Inferior Myocardial Infarction

Background: The patient with inferior wall AMI, site of culprit lesions is an important determinant of outcome. Patient with RV infarction have a poor prognosis whereas those with occlusion of LCX have a good prognosis. Early diagnosis and treatment substantially reduce cardiac events particularly in high-risk patients. V4R can be used as to locate the site of obstruction. Materials and methods: 81 patients with acute inferior myocardial infarction admitted to the coronary care unit (CCU) within 12 hours after the onset of chest pain who underwent coronary angiogram were included in the study. Standard 12-lead ECG with right precordial lead V4R was recorded. Patients were categorized into within 3 groups according to early changes of V4R-Group- I - ST-segment elevation > 1 mm and positive T- wave, Group-II- ST-segment iso-electric and positive T-wave, Group-III- ST-segment depression >1 mm and negative T -wave. Results: In group I patients, highest percentage of the patients had lesion in proximal RCA (97.2%); whereas in group II patients, highest percentage in the distal RCA (89.7%) followed by LCX (41.4%) and in group III patients, highest percentage also in LCX (100.0%) followed by LAD (56.3%). Based on analysis of sensitivity and specificity, it was revealed that in group I patients of ECG finding suggested 100.0% sensitivity, 97.8% specificity and 98.8% accuracy. In group II patients, 92.9% sensitivity, 94.3% specificity and 93.8% had accuracy. In case of group III patients, 93.8% sensitivity, 98.5% specificity and 97.5% accuracy. Conclusion: The configuration of the ST-T segment in lead V4R is a sensitive and specific tool to recognize the occluded vessel in acute inferior MI whether it is proximal RCA, distal RCA or LCX. Since it is an inexpensive method, it can be readily used to locate the site of occlusion in AMI - Inferior. Keywords: Coronary artery disease; Myocardial infarction;, Lead V4r. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9389 Cardiovasc. J. 2011; 4(1): 46-52

scholarly journals A soft voting ensemble classifier for early prediction and diagnosis of occurrences of major adverse cardiovascular events for STEMI and NSTEMI during 2-year follow-up in patients with acute coronary syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0249338
Author(s):  
Syed Waseem Abbas Sherazi ◽  
Jang-Whan Bae ◽  
Jong Yun Lee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Ensemble Classifier ◽  
Major Adverse Cardiovascular Events ◽  
Test Dataset ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Complete Dataset ◽  
St Segment

Objective Some researchers have studied about early prediction and diagnosis of major adverse cardiovascular events (MACE), but their accuracies were not high. Therefore, this paper proposes a soft voting ensemble classifier (SVE) using machine learning (ML) algorithms. Methods We used the Korea Acute Myocardial Infarction Registry dataset and selected 11,189 subjects among 13,104 with the 2-year follow-up. It was subdivided into two groups (ST-segment elevation myocardial infarction (STEMI), non ST-segment elevation myocardial infarction NSTEMI), and then subdivided into training (70%) and test dataset (30%). Third, we selected the ranges of hyper-parameters to find the best prediction model from random forest (RF), extra tree (ET), gradient boosting machine (GBM), and SVE. We generated each ML-based model with the best hyper-parameters, evaluated by 5-fold stratified cross-validation, and then verified by test dataset. Lastly, we compared the performance in the area under the ROC curve (AUC), accuracy, precision, recall, and F-score. Results The accuracies for RF, ET, GBM, and SVE were (88.85%, 88.94%, 87.84%, 90.93%) for complete dataset, (84.81%, 85.00%, 83.70%, 89.07%) STEMI, (88.81%, 88.05%, 91.23%, 91.38%) NSTEMI. The AUC values in RF were (98.96%, 98.15%, 98.81%), ET (99.54%, 99.02%, 99.00%), GBM (98.92%, 99.33%, 99.41%), and SVE (99.61%, 99.49%, 99.42%) for complete dataset, STEMI, and NSTEMI, respectively. Consequently, the accuracy and AUC in SVE outperformed other ML models. Conclusions The performance of our SVE was significantly higher than other machine learning models (RF, ET, GBM) and its major prognostic factors were different. This paper will lead to the development of early risk prediction and diagnosis tool of MACE in ACS patients.

scholarly journals A Nomogram Based on Apelin-12 for the Prediction of Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention among Patients with ST-Segment Elevation Myocardial Infarction

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Enfa Zhao ◽  
Hang Xie ◽  
Yushun Zhang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Objective. This study aimed to establish a clinical prognostic nomogram for predicting major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention (PCI) among patients with ST-segment elevation myocardial infarction (STEMI). Methods. Information on 464 patients with STEMI who performed PCI procedures was included. After removing patients with incomplete clinical information, a total of 460 patients followed for 2.5 years were randomly divided into evaluation (n = 324) and validation (n = 136) cohorts. A multivariate Cox proportional hazards regression model was used to identify the significant factors associated with MACEs in the evaluation cohort, and then they were incorporated into the nomogram. The performance of the nomogram was evaluated by the discrimination, calibration, and clinical usefulness. Results. Apelin-12 change rate, apelin-12 level, age, pathological Q wave, myocardial infarction history, anterior wall myocardial infarction, Killip’s classification > I, uric acid, total cholesterol, cTnI, and the left atrial diameter were independently associated with MACEs (all P<0.05). After incorporating these 11 factors, the nomogram achieved good concordance indexes of 0.758 (95%CI = 0.707–0.809) and 0.763 (95%CI = 0.689–0.837) in predicting MACEs in the evaluation and validation cohorts, respectively, and had well-fitted calibration curves. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions. We established and validated a novel nomogram that can provide individual prediction of MACEs for patients with STEMI after PCI procedures in a Chinese population. This practical prognostic nomogram may help clinicians in decision making and enable a more accurate risk assessment.

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