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ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 80-85

The Pattern of reciprocal electrocardiography changes in St-segment elevation myocardial infarction patients presenting with single-vessel disease versus multi-vessel disease


Department of Cardiology, Ainshams University, Cairo, Egypt

Correspondence Address:
Dr. Mohamed Elsayed Zahran
Doctor Mohamed Zahran's Cardiology Clinic, 3, Abdelazeem Awadallah Street, Higaz Square, Heliopolis, Postal Code: 11786, Cairo; Ainshams University Hospitals, Cardiology Department, Abbasia Square, Ramses Street, Postal Code: 11517, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCA.IJCA_2_19

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Introduction: The reciprocal ST-segment depression in the electrocardiography (ECG) leads overlying noninfarcting areas was studied previously in acute myocardial ischemia. Multi-vessel disease (MVD) subset of patients have more vague and confusing presentations on ECG; they usually show less ST-segment elevation and profound and diffuse ST-segment depression compared to ST-segment elevation myocardial infarction (STEMI) patients with single-vessel disease (SVD) involving occlusion of one coronary artery only, namely the infarct-related artery (IRA). Aim of the Work: The aim was to study and compare the pattern of reciprocal ECG changes in STEMI patients presenting with SVD versus MVD. Methods and Results: A total of 125 consecutive patients admitted from April 2014 to August 2015 from the emergency room with the diagnosis of acute STEMI and treated by primary percutaneous coronary intervention (PPCI) at our cath lab at Ainshams University Hospitals (a 24/7 tertiary referral center for PPCI) were included. ST-segment deviations were measured at the J-point. Reciprocal ST-segment changes were identified as per guidelines published by the European Society of Cardiology and the American College of Cardiology, i.e., ST-segment depression ≥0.1 mV in any ECG lead other than aVR, while the cutoff value is different for leads V2 and V3 being only 0.05 mV. Coronary angiographies were evaluated by two independent operators blinded to the clinical and electrocardiographic data. Regarding the left anterior descending (LAD) occlusion, the reciprocal ST-segment depression magnitudes in lead III and in lead arteriovenous fistula (aVF) were significantly less in the MVD group compared to the SVD group, i.e., lead III (−0.08 ± 0.10 mV vs. −0.19 ± 0.15, P = 0.015) and lead aVF (−0.07 ± 0.06 mV vs. −0.15 ± 0.11, P = 0.02); while regarding the left circumflex coronary artery (LCX) occlusion, the reciprocal ST-segment depression extended significantly in V4 chest lead in the MVD group compared to the SVD group (−0.16 ± 0.08 mV vs. −0.1 ± 0.04, P = 0.025); and finally regarding the right coronary artery (RCA) occlusion, the reciprocal ST-segment depression extended significantly in V3 chest lead in the MVD group compared to the SVD group (−0.18 ± 0.07 mV vs. −0.1 ± 0.06, P = 0.02). Conclusion: The pattern of reciprocal ST-segment depression was more profound when the LAD was the culprit artery causing the anterior STEMI compared to the same case if the LAD was a part of MVD; this does not apply to the LCX and RCA when they were the culprit in cases of inferior STEMI where the MVD group showed more reciprocal ST-segment depression.


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