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

Cardiology. 2018;139(1):53-61. doi: 10.1159/000481814. Epub 2017 Dec 14.

Abstract

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.

Keywords: Coronary artery disease; Electrocardiography; Inferior derivation; Myocardial infarction.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Electrocardiography
  • Female
  • Heart Diseases / epidemiology
  • Hospital Mortality*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / complications
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / therapy
  • Non-ST Elevated Myocardial Infarction / complications
  • Non-ST Elevated Myocardial Infarction / mortality
  • Non-ST Elevated Myocardial Infarction / therapy
  • Outcome Assessment, Health Care
  • Percutaneous Coronary Intervention
  • Prognosis
  • Prospective Studies
  • ST Elevation Myocardial Infarction / complications
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy
  • Shock, Cardiogenic / etiology