Y. Birnbaum et al., PROGNOSTIC-SIGNIFICANCE OF PRECORDIAL ST SEGMENT DEPRESSION ON ADMISSION ELECTROCARDIOGRAM IN PATIENTS WITH INFERIOR WALL MYOCARDIAL-INFARCTION, Journal of the American College of Cardiology, 28(2), 1996, pp. 313-318
Objectives. This study assessed retrospectively the correlation betwee
n the pattern of precordial ST segment depression on the admission ele
ctrocardiogram (EGG) and hospital mortality in patients with an inferi
or myocardial infarction treated with intravenous thrombolytic therapy
. Background. Previous studies have shown that in acute inferior myoca
rdial infarction, ST segment depression in the precordial leads is ass
ociated with increased hospital mortality. However, the significance o
f the different patterns of precordial ST segment depression has been
evaluated in only two previous studies. Methods. The study included 1,
321 patients (1,020 men) who enrolled in the Global Utilization of Str
eptokinase and t-PA for Occluded Coronary Arteries (GUSTO I) trial in
Israel and received intravenous thrombolytic therapy, Patients with an
ST segment elevation greater than or equal to 0.1 mV in at least two
of the inferior leads were included, Patients were classified into fou
r groups on the basis of their admission EGG: group I = patients with
no precordial ST segment depression (n = 346); group II = those for wh
om the sum of ST segment depression in leads V-1 to V-3 was greater th
an that in leads V-4 to V-6 (n = 700); group III = those for whom the
sum of ST depression in leads V-1 to V-3 was equal to that in leads V-
4 to V-6 (n = 162); group IV = those with maximal ST depression in lea
ds V-4 to V-6 (n = 113). Results. The overall hospital mortality rate
was 3.6% (48 patients): for groups I, II, III and IV it was 2.9%, 2.8%
, 4.3% and 9.7%, respectively. Multivariable logistic regression analy
sis confirmed that hospital mortality was independently associated wit
h the pattern of precordial ST segment depression. The odd ratios in g
roup TV relative to group I was 2.78 (95% confidence interval 1.26 to
6.13, p = 0.007). Conclusions. The risk of mortality is higher in pati
ents with an inferior myocardial infarction and maximal ST segment dep
ression in precordial leads V-4 to V-6 versus precordial leads V-1 to
V-3 on the admission EGG.