Abstract
Background: Concurrent atrial ischemia is usually overlooked in acute myocardial infarction (MI) due to its subtle electrocardiographic (ECG) changes, lack of clear‐cut clinical picture, and prognostic significance. PR‐segment depression in the inferior leads is a simplified ECG sign for detecting possible underlying atrial ischemia.
Hypothesis: The purpose of this study was to document the incidence, clinical characteristics, and prognostic implications of this ECG sign in the setting of acute inferior MI.
Methods: Demographics, clinical characteristics, and outcomes of 463 consecutive patients presenting with acute inferior MI were reviewed. The in‐hospital ECG was examined by two independent reviewers. The results were then compared between those with and without ECG sign.
Results: Profound PR‐segment depression ≥ 1.2 mm in inferior leads was found in 9 of 463 (1.9%) patients. Patients with atrial ischemia tended to present earlier (2.4 ± 2.6 vs. 7.0 ± 8.2 h, p = 0.000) and had a higher frequency of first‐degree atrioventricular block (77.8 vs. 30.6%, p = 0.028) and supra‐ventricular arrhythmias (55.5 vs. 20.2%, p = 0.022). Of greater importance, it was significantly associated with an increased rate of cardiac free‐wall rupture (33.3 vs. 2.0%, p = 0.001) and in‐hospital mortality (44.4 vs. 11.7%, p = 0.015).
Conclusion: Profound PR‐segment depression > 1.2 mm in inferior leads was associated with a complicated hospital course and poor short‐term outcome in acute inferior MI. These patients were at high risk for the development of atrioventricular block, supraventricular arrhythmias, and cardiac free‐wall rupture.
Keywords: PR‐segment depression, atrial infarction, in‐hospital mortality, cardiac free‐wall rupture
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