Influence of the extent of coronary atherosclerotic disease on ST-segment changes induced by ST elevation myocardial infarction
Noriega, Francisco J. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Vives-Borrás, Miquel (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Solé González, Eduard (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
García-Picart, Joan (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
Cinca, Juan (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2014
Abstract:	The accuracy of the admission electrocardiogram (ECG) in predicting the site of acute coronary artery occlusion in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease is not well known. This study aimed to assess whether the presence of multivessel coronary artery disease (CAD) modifies the artery-related ST-segment changes in patients with acute coronary artery occlusion. We reviewed the admission ECG, clinical records, and coronary angiography of 289 patients with STEMI caused by acute occlusion of left anterior descending (LAD; n = 140), right (n = 118), or left circumflex (LCx; n = 31) coronary arteries. All patients underwent primary percutaneous coronary reperfusion during the first 12 hours. The magnitude and distribution of artery-related ST-segment patterns were comparable in patients with single (n = 149) and multivessel (n = 140) CAD. Occlusion of proximal (n = 55) or mid-distal (n = 85) LAD artery induced ST-segment elevation in leads V to V, but only the proximal occlusion induced reciprocal ST-segment depression in leads II, III, and aVF (p <0. 001). Proximal and mid-distal occlusion of right (n = 45 and 73, respectively) or LCx (n = 15 and 16) coronary artery always induced ST-segment elevation in leads II, III, and aVF and reciprocal ST-segment depression in leads V and V. ST-segment elevation in lead V >0. 1 mV predicted LCx artery occlusion. In conclusion, patients with STEMI with single or multivessel CAD have concordant artery-related ST-segment patterns on the admission ECG; in both groups, reciprocal ST-segment depression in LAD artery occlusion predicts a large infarct. Subendocardial ischemia at a distance is not a requisite for the genesis of reciprocal ST-segment changes.
Grants:	Fundació la Marató de TV3 080630-2007
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	American Journal of Cardiology, Vol. 113 Núm. 5 (january 2014) , p. 757-764, ISSN 1879-1913

DOI: 10.1016/j.amjcard.2013.11.034
PMID: 24406107

8 p, 2.4 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles