Unstable angina: ST segment depression with positive versus negative T wave deflections--clinical course, ECG evolution, and angiographic correlation.
Thirty-two consecutive patients who initially had horizontal or downward-sloping ST segment depression confined to the precordial leads were studied. Patients were divided into two groups: group A included 21 patients with horizontal or downward-sloping ST depression with peaked positive T waves, and group B comprised 11 patients with peaked negative T waves and downward or horizontal ST depression. The incidence of acute myocardial infarction (AMI) was similar (group A 38.1% vs group B 36.4%; p greater than 0.05). In-hospital mortality was much more significant in group B (p = 0.03). Coronary arteriography was performed in 31 patients. Of the 10 patients in group B who were catheterized, seven (70%) had left main occlusion. Of the 21 patients in group A, none had a significant left main lesion (p = 0.001), although eight (38.1%) had single-vessel disease (p = 0.05). Thus the ECG pattern of horizontal or downward-sloping ST depression passing into a peaked negative T wave identifies a subgroup of high-risk patients in whom the prognosis is poor once AMI occurs. Early catheterization is recommended when this ischemic pattern is apparent on the ECG.
Sclarovsky
S
S
Israel and Ione Massada Center for Heart Diseases, Beilinson Medical Center, Petah Tikva, Israel.
Rechavia
E
E
Strasberg
B
B
Sagie
A
A
Bassevich
R
R
Kusniec
J
J
Mager
A
A
Agmon
J
J
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis*; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D000792:Angiography; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors