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 Incidence of 'Precordial ST-Segment Depression' in Acute Inferior Myocardial Infarction

1970 ◽  
Vol 6 (1) ◽  
pp. 21-22
Author(s):  
Md Mobashir Khalil ◽  
AKM Fazlur Rahman ◽  
Chowdhury Meshkat Ahmed ◽  
Shah Md Iqbal ◽  
KMHS Sirajul Haque
Keyword(s):  
Myocardial Infarction ◽  
Age Group ◽  
Inferior Myocardial Infarction ◽  
Younger Patients ◽  
St Segment Elevation ◽  
St Segment ◽  
Number Of Patients ◽  
Group 2 ◽  
Acute Inferior Myocardial Infarction ◽  
Group 1

Patients of acute inferior myocardial infarction, in addition to the ST segment elevation in inferior leads often have ST segment depression in the precordial leads. This study was performed to observe the incidence of these ‘reciprocal’ ST changes. One hundred consecutive acute inferior myocardial infarction patients were included in the study. They were further allocated to two electrocardiographic groups. Group 1 consisted of patients of acute inferior myocardial infarction with precordial ST segment depression & Group 2 consisted of patients of acute inferior myocardial infarction without precordial ST segment depression. Among the 100 consecutive patients, a large number of patients were included in group 1 (76%). Significant number of patients of group 1 belonged to the age group of above 60 years compared to group 2 (27.6% vs. 4.2%; p < .02). Conversely significantly higher number of younger patients ≤ 40 years belonged to group 2 (41.7% vs. 11.9%; p < .01). Mean ST segment elevation (mm) was also significantly higher in group 1 than group 2 (4.07 ± 1.93 vs. 2 ± 0.78; p <.001). The patients of acute inferior myocardial infarction thus show a significant number of ST segment depression in their precordial leads. In different studies these subset of patients showed increased morbidity and mortality. Key words: acute inferior myocardial infarction; precordial ST segment depression. DOI: 10.3329/uhj.v6i1.7185University Heart Journal Vol.6(1) 2010 pp.21-22

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).

ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽  
2017 ◽  
Vol 139 (1) ◽  
pp. 53-61
Author(s):  
Mert İlker Hayıroğlu ◽  
Ahmet Okan Uzun ◽  
Ceyhan Türkkan ◽  
Muhammed Keskin ◽  
Edibe Betül Börklü ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Death ◽  
Anterior Myocardial Infarction ◽  
St Depression ◽  
St Segment ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

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

The Neutrophil to Lymphocyte Ratio (NLR) Is Associated With Residual Syntax Score in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽  
2020 ◽  
pp. 000331972095855
Author(s):  
Serkan Kahraman ◽  
Hicaz Zencirkiran Agus ◽  
Yalcin Avci ◽  
Nail Guven Serbest ◽  
Ahmet Guner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Independent Predictor ◽  
Syntax Score ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Group 2 ◽  
Residual Syntax Score ◽  
Group 1

The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (<2.59) and group 2 with high NLR (>2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.

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