Value of the initial electrocardiogram in patients with inferior-wall acute myocardial infarction for prediction of multivessel coronary artery disease

Background Patients with inferior-wall acute myocardial infarction (AMI) wh o have ST-segment depression in the left precordial leads (LSTD+) on the in itial electrocardiogram were reported to have more diffuse coronary artery disease (CAD) than had those without this finding (LSTD-). This suggests th at LSTD+ patients may need extensive revascularization interventions more o ften than do LSTD- patients. However, this has not yet been confirmed. Objective To compare the coronary angiographic findings and treatment strat egies for patients with inferior-wall AMI according to the LSTD pattern. Methods The clinical outcomes and the angiographic findings for 238 consecu tive patients aged less than or equal to 75 years who had been admitted to our hospital between 1 February 1995 and 1 February 1997 with inferior-wall AMI were retrospectively analyzed. The patients were divided into two grou ps according to the pattern of precordial ST-segment depression: LSTD+, ST- segment depression in leads V4-V6; and LSTD-, absence of this finding. All patients were treated according to current practice guidelines including wi th thrombolysis and revascularization interventions. Results The final study population included 217 patients; 83 were LSTD+ and 134 were LSTD-. All underwent coronary angiography within 30 days of the i nfarction. Compared with LSTD- patients, LSTD+ patients tended to be older (mean age 62.7 +/- 11.7 versus 58.3 +/- 9.6 years, P = 0.004), and had high er incidences of hypertension (39.8 versus 24.6%, P = 0.019) previous myoca rdial infarction (45.8 versus 20.1%, P = 0.0001) and congestive heart failu re (21.7 versus 3.7%, P = 0.00008). Three-vessel CAD was much more common, and single-vessel CAD much less common, in the LSTD +than in LSTD- group (6 2.7 versus 13.4% and 8.4 versus 50.7%, P < 0.00001 for both). Coronary-arte ry-bypass surgery and multivessel percutaneous coronary interventions (PCI) were used in treating 65.1% of the LSTD+versus only 6.0% of the LSTD- pati ents (P < 0.00001), whereas single-vessel PCI was used in treating 71.6% of the LSTD- patients versus only 24.1% of the LSTD + patients (P < 0.00001). Thus, the LSTD- pattern predicted single-vessel disease and single-vessel PCI only, whereas the LSTD+pattern was predictive of multivessel CAD and of use of coronary-artery-bypass surgery or multivessel PCI (predictive value s of 94.0 and 65.1%, respectively). Conclusions Among patients with inferior-wall AMI, left precordial ST-segme nt depression predicts a very high prevalence of multivessel CAD and use of extensive revascularization interventions. The absence of this finding pre dicts nondiffuse CAD and lack of a need for extensive revascularization. Co ron Artery Dis 11:415-420 (C) 2000 Lippincott Williams & Wilkins.