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. 1995 Dec;74(6):611–614. doi: 10.1136/hrt.74.6.611

Clinical significance of inferior ST elevation during acute anterior myocardial infarction.

A Tamura 1, H Kataoka 1, K Nagase 1, Y Mikuriya 1, M Nasu 1
PMCID: PMC484115  PMID: 8541164

Abstract

OBJECTIVES--To clarify the genesis and clinical significance of inferior ST elevation during acute anterior myocardial infarction. PATIENTS AND DESIGN--A total of 106 patients with first acute anterior myocardial infarction (< or = 6 h) were divided into two groups according to the presence (group A, n = 12) or absence (group B, n = 94) of ST elevation of > or = 1 mm in at least two of the inferior leads on the admission electrocardiogram. RESULTS--On admission electrocardiograms, group A had a smaller summed ST deviation in the lateral limb leads than group B. On emergency coronary arteriograms, the incidence of a wrapped left anterior descending artery was higher in group A than in group B (100% v 27%, P < 0.01). The incidence of occlusion of a left anterior descending artery distal to its first diagonal branch was higher in group A than in group B (100% v 46%, P < 0.01). Peak serum creatine kinase activity and in-hospital mortality tended to be lower in group A than in group B. Group A had better left ventricular ejection fraction and regional wall motion in the anterobasal and anterolateral regions in the chronic phase than group B. In contrast, regional wall motion in the diaphragmatic region was reduced to a greater extent in group A than in group B. CONCLUSIONS--Inferior ST elevation during acute anterior myocardial infarction appears only in the presence of a combination of a lesser degree of transmural ischaemic myocardium in the anterobasal and anterolateral wall together with transmural ischaemic myocardium in the inferior wall; in all cases there was occlusion of a wrapped left anterior descending artery distal to its first diagonal branch. Patients with such an ST elevation appear to have a better in-hospital prognosis than those without it.

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Selected References

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  1. Haraphongse M., Tanomsup S., Jugdutt B. I. Inferior ST segment depression during acute anterior myocardial infarction: clinical and angiographic correlations. J Am Coll Cardiol. 1984 Sep;4(3):467–476. doi: 10.1016/s0735-1097(84)80089-3. [DOI] [PubMed] [Google Scholar]
  2. Ilia R., Goldfarb B., Ovsyshcher I. A. Concomittant ST elevation in inferior and anterior leads in acute myocardial infarction. Clinical and anatomical significance. J Electrocardiol. 1990 Jul;23(3):199–205. doi: 10.1016/0022-0736(90)90157-w. [DOI] [PubMed] [Google Scholar]
  3. Iwasaki K., Kusachi S., Kita T., Taniguchi G. Prediction of isolated first diagonal branch occlusion by 12-lead electrocardiography: ST segment shift in leads I and aVL. J Am Coll Cardiol. 1994 Jun;23(7):1557–1561. doi: 10.1016/0735-1097(94)90656-4. [DOI] [PubMed] [Google Scholar]
  4. Lew A. S., Hod H., Cercek B., Shah P. K., Ganz W. Inferior ST segment changes during acute anterior myocardial infarction: a marker of the presence or absence of concomitant inferior wall ischemia. J Am Coll Cardiol. 1987 Sep;10(3):519–526. doi: 10.1016/s0735-1097(87)80193-6. [DOI] [PubMed] [Google Scholar]
  5. Norell M. S., Lyons J. P., Gardener J. E., Layton C. A., Balcon R. Significance of "reciprocal" ST segment depression: left ventriculographic observations during left anterior descending coronary angioplasty. J Am Coll Cardiol. 1989 May;13(6):1270–1274. doi: 10.1016/0735-1097(89)90299-4. [DOI] [PubMed] [Google Scholar]
  6. Quyyumi A. A., Crake T., Rubens M. B., Levy R. D., Rickards A. F., Fox K. M. Importance of "reciprocal" electrocardiographic changes during occlusion of left anterior descending coronary artery. Studies during percutaneous transluminal coronary angioplasty. Lancet. 1986 Feb 15;1(8477):347–350. doi: 10.1016/s0140-6736(86)92317-2. [DOI] [PubMed] [Google Scholar]
  7. Rentrop K. P., Cohen M., Blanke H., Phillips R. A. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985 Mar;5(3):587–592. doi: 10.1016/s0735-1097(85)80380-6. [DOI] [PubMed] [Google Scholar]
  8. Sapin P. M., Musselman D. R., Dehmer G. J., Cascio W. E. Implications of inferior ST-segment elevation accompanying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and site of occlusion. Am J Cardiol. 1992 Apr 1;69(9):860–865. doi: 10.1016/0002-9149(92)90783-u. [DOI] [PubMed] [Google Scholar]
  9. Sheehan F. H., Bolson E. L., Dodge H. T., Mathey D. G., Schofer J., Woo H. W. Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation. 1986 Aug;74(2):293–305. doi: 10.1161/01.cir.74.2.293. [DOI] [PubMed] [Google Scholar]
  10. Simoons M. L., Serruys P. W., van den Brand M., Res J., Verheugt F. W., Krauss X. H., Remme W. J., Bär F., de Zwaan C., van der Laarse A. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. J Am Coll Cardiol. 1986 Apr;7(4):717–728. doi: 10.1016/s0735-1097(86)80329-1. [DOI] [PubMed] [Google Scholar]

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