{"title":"Significance of reciprocal ST segment depression in ST elevation myocardial infarction","authors":"Mahmoud K. Nour MD","doi":"10.1016/j.ejccm.2017.01.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The significance of reciprocal ST segment depression during acute myocardial infarction has been an area of debate, whether it is a sign of multivessel disease, ischemia at a distance or merely a benign electrical phenomenon.</p></div><div><h3>Objective</h3><p>To study the relation between the presence of reciprocal ST segment depression in ST elevation myocardial infarction, extent of coronary artery disease & left ventricular systolic function.</p></div><div><h3>Patients and methods</h3><p>A prospective, controlled study involving 200 ST elevation myocardial infarction patients (100 inferior, 100 anterior), each group was sub-grouped into 2 subgroups according to the presence of reciprocal ST segment depression or absence: in anterior STEMI group we had subgroup A1 with RSTD (41 patients) and subgroup A2 without RSTD (59 patients) while in inferior STEMI group each subgroup (B1 and B2) consisted of 50 patients. Echocardiography & coronary angiography were done for all patients.</p></div><div><h3>Results</h3><p>Patients with reciprocal ST segment depression showed a significant lower mean Left ventricular ejection fraction compared to those without (37<!--> <!-->+<!--> <!-->3% vs 53<!--> <!-->+<!--> <!-->5% P<!--> <!--><<!--> <!-->0.001, anterior ST elevation myocardial infarction subgroups) & (47<!--> <!-->+<!--> <!-->4% vs 60<!--> <!-->+<!--> <!-->3% P<!--> <!--><<!--> <!-->0.001, inferior ST elevation myocardial infarction subgroups). Higher incidence of multivessel disease was found in subgroups with reciprocal ST segment depression (80.5% vs 49.2%, P<!--> <!--><<!--> <!-->0.001 in anterior ST elevation myocardial infarction) & (60% vs 20%, P<!--> <!--><<!--> <!-->0.001 in inferior ST elevation myocardial infarction). The mean modified gensini score was higher in subgroups with reciprocal ST segment depression (64.2<!--> <!-->+<!--> <!-->12.6 vs 30.2<!--> <!-->+<!--> <!-->6.6, P<!--> <!--><<!--> <!-->0.001 in anterior infarction group) & (36.2<!--> <!-->+<!--> <!-->10.6<!--> <!-->vs 20.4<!--> <!-->+<!--> <!-->4.2, p<!--> <!--><<!--> <!-->0.001 in inferior infarction group).</p></div><div><h3>Conclusion</h3><p>Reciprocal ST segment depression in acute myocardial infarction was associated with significant LV systolic dysfunction & greater extent of coronary artery disease.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3000,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2017.01.003","citationCount":"6","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Journal of Critical Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2090730317300038","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 6
Abstract
Background
The significance of reciprocal ST segment depression during acute myocardial infarction has been an area of debate, whether it is a sign of multivessel disease, ischemia at a distance or merely a benign electrical phenomenon.
Objective
To study the relation between the presence of reciprocal ST segment depression in ST elevation myocardial infarction, extent of coronary artery disease & left ventricular systolic function.
Patients and methods
A prospective, controlled study involving 200 ST elevation myocardial infarction patients (100 inferior, 100 anterior), each group was sub-grouped into 2 subgroups according to the presence of reciprocal ST segment depression or absence: in anterior STEMI group we had subgroup A1 with RSTD (41 patients) and subgroup A2 without RSTD (59 patients) while in inferior STEMI group each subgroup (B1 and B2) consisted of 50 patients. Echocardiography & coronary angiography were done for all patients.
Results
Patients with reciprocal ST segment depression showed a significant lower mean Left ventricular ejection fraction compared to those without (37 + 3% vs 53 + 5% P < 0.001, anterior ST elevation myocardial infarction subgroups) & (47 + 4% vs 60 + 3% P < 0.001, inferior ST elevation myocardial infarction subgroups). Higher incidence of multivessel disease was found in subgroups with reciprocal ST segment depression (80.5% vs 49.2%, P < 0.001 in anterior ST elevation myocardial infarction) & (60% vs 20%, P < 0.001 in inferior ST elevation myocardial infarction). The mean modified gensini score was higher in subgroups with reciprocal ST segment depression (64.2 + 12.6 vs 30.2 + 6.6, P < 0.001 in anterior infarction group) & (36.2 + 10.6 vs 20.4 + 4.2, p < 0.001 in inferior infarction group).
Conclusion
Reciprocal ST segment depression in acute myocardial infarction was associated with significant LV systolic dysfunction & greater extent of coronary artery disease.
急性心肌梗死期间ST段互降的意义一直是一个有争议的领域,它是多血管疾病、远处缺血还是仅仅是一种良性电现象的标志。目的探讨ST段抬高型心肌梗死ST段互降与冠状动脉病变程度的关系;左心室收缩功能。患者与方法一项前瞻性对照研究,纳入200例ST段抬高型心肌梗死患者(100例下位,100例前位),每组根据是否存在ST段相互抑制分为2个亚组:前位STEMI组有伴RSTD的A1亚组(41例)和无RSTD的A2亚组(59例),下位STEMI组各亚组(B1和B2)各50例。超声心动图和所有患者均行冠状动脉造影。结果ST段互降患者的平均左室射血分数明显低于非ST段互降患者(37 + 3% vs 53 + 5% P <0.001,前ST段抬高心肌梗死亚组)&(47 + 4% vs 60 + 3% P <0.001,下ST段抬高心肌梗死亚组)。多支血管疾病的发生率在ST段互降亚组中较高(80.5% vs 49.2%, P <ST段抬高心肌梗死0.001)&(60% vs 20%, P <下ST段抬高型心肌梗死0.001)。ST段相互凹陷的亚组改良gensini平均评分更高(64.2 + 12.6 vs 30.2 + 6.6, P <前壁梗死组0.001)&(36.2 + 10.6 vs 20.4 + 4.2, p <下壁梗死组0.001)。结论急性心肌梗死ST段互降与左室收缩功能障碍相关;更严重的冠状动脉疾病。
期刊介绍:
The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.