Correlation of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction

This study assessed whether differences in the underlying mechanisms for various patterns of precardial ST-segment depression with inferior acute myocardial infarction (AMI) are associated with poorer prognoses. We studied 1,155 patients with inferior AMI who under went thrombolysis in the Global Utilization of Streptokinase and TPA for Occluded arteries (GUSTO-1) angiographic substudy: those without precordial ST depression (n = 412; 35.7%), those with maximum ST depression in leads V-1 to V-3 (n = 547; 47.4%), and those with maximum ST depression in leads V-4 to V-6 (n = 196; 17.0%) on admission electrocardiogram, We compared the infarct-related artery, presence of left anterior descending or multivessel coronary artery disease, and left ventricular function among groups. Patients with maximum ST depression in leads V-4 to V-6 more often had 3-vessel disease (26.0%) than those without precordial ST depression (13.5%) or those with ST depression in leads V-1 to V-3 (15.7%; p = 0.002), and had a lower ejection fraction (median 54% vs 60% 55%, respectively; p < 0.001). Patients with maximum ST depression in leads V-1 to V-3 less often had AMls due to proximal right coronary artery obstruction (23.9%) than patients without precardial ST depression (35.2%) or those with ST depression in leads V-4 to V-6 (40.0%; p = 0.001) and had larger AMls as estimated by peak creatine kinase. Different patterns of precardial ST depression are associated with distinctive coronary anatomy. ST depression in leads V-4 to V-6, but not V-1 to V-3, confers a greater likelihood of multivessel coronary artery disease. (C) 1999 by Excerpta Medica, Inc.