Clinical significance of reciprocal ST segment depression in acute myocardial infarction: Analysis based on the time interval from the onset of symptoms

Chang, Hyuk Jae; Park, In Whee; Kim, Jung Eun; Lee, Jong Woo; Choi, So Yeon; Hwang, Gyo Seung; Yoon, Myeong Ho; Shin, Joon Han; Tahk, Seung Jea; Choi, Byung Il

Abstract

BACKGROUND: To investigate the clinical significance of reciprocal ST segment depression on the presenting electrocardiogram (ECG) in patients with acute myocardial infarction (MI), in particular, this study focuses whether there is any difference according to the time interval between the onset of symptoms and initial ECG.
METHODS
ECG findings in 198 patients with acute MI were retrospectively reviewed. The patients were classified into 4 subgroups based on the infarct region and reciprocal ST depression. The clinical data and angiographic finding were compared in each region. We also explored whether any differences could be recognized according to the time interval.
RESULTS
Of 78 anterior MI, 16 (21%) showed a reciprocal ST depression and 62 (80%) did not. Of 120 inferior MI, 50 (41%) displayed a reciprocal ST depression and 70 (59%) did not. In each region, a reciprocal ST depression made no difference between the two groups. However, when divided by the time interval, a reciprocal ST depression more than 4 hours after MI predicted a high incidence of multivessel disease [anterior MI 5/6 (83%), 10/12 (83%): p<0.05 for each].
CONCLUSION
There was a high incidence of multivessel disease when a reciprocal ST segment depression continued for more than 4 hours after MI. The meaning of a reciprocal ST depression can be interpreted differently according to the duration after MI.