ST Depression, No ST Change, or ST Elevation in Inferior Derivations

Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Hayıroğlu, Mert İlker
Uzun, Ahmet Okan
Türkkan, Ceyhan
Keskin, Muhammed
Börklü, Edibe Betül
Tekkesin, Ahmet İlker
Kozan, Ömer

^aDepartment of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, and ^bDepartment of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, and ^cDepartment of Cardiology, Hatay Dortyol State Hospital, Hatay, Turkey

*Mert İlker Hayıroğlu, MD, Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, TR-34668 Istanbul (Turkey), E-Mail [email protected]

Received August 02, 2017

Accepted September 13, 2017

Cardiology 139(1):p 53-61, January 2018. | DOI: 10.1159/000481814

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.