Correlation of angiographic findings and right (V-1 to V-3) versus left (V-4 to V-6) precordial ST-segment depression in inferior wall acute myocardial infarction

This study assessed whether differences in the underlying mechanisms for va rious patterns of precardial ST-segment depression with inferior acute myoc ardial infarction (AMI) are associated with poorer prognoses. We studied 1, 155 patients with inferior AMI who under went thrombolysis in the Global Ut ilization of Streptokinase and TPA for Occluded arteries (GUSTO-1) angiogra phic substudy: those without precordial ST depression (n = 412; 35.7%), tho se with maximum ST depression in leads V-1 to V-3 (n = 547; 47.4%), and tho se with maximum ST depression in leads V-4 to V-6 (n = 196; 17.0%) on admis sion electrocardiogram, We compared the infarct-related artery, presence of left anterior descending or multivessel coronary artery disease, and left ventricular function among groups. Patients with maximum ST depression in l eads V-4 to V-6 more often had 3-vessel disease (26.0%) than those without precordial ST depression (13.5%) or those with ST depression in leads V-1 t o V-3 (15.7%; p = 0.002), and had a lower ejection fraction (median 54% vs 60% 55%, respectively; p < 0.001). Patients with maximum ST depression in l eads V-1 to V-3 less often had AMls due to proximal right coronary artery o bstruction (23.9%) than patients without precardial ST depression (35.2%) o r those with ST depression in leads V-4 to V-6 (40.0%; p = 0.001) and had l arger AMls as estimated by peak creatine kinase. Different patterns of prec ardial ST depression are associated with distinctive coronary anatomy. ST d epression in leads V-4 to V-6, but not V-1 to V-3, confers a greater likeli hood of multivessel coronary artery disease. (C) 1999 by Excerpta Medica, I nc.