CLINICAL HEMODYNAMIC STUDY OF RECIPROCAL ST SEGMENT CHANGES IN ACUTE INFERIOR MYOCARDIAL INFARCTION

Abstract

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.