Stress-induced ST-segment elevation in patients without prior Q-wave myocardial infarction.
BACKGROUND
Stress-induced ST-segment elevation is an uncommon finding that usually occurs in patients with prior myocardial infarction (MI). Our purpose was to assess the angiographic and clinical significance of this finding in patients without prior MI.


METHODS
Of the 29002 consecutive ambulatory patients who underwent stress myocardial perfusion imaging over a 5-year period, 205 (0.7%) developed stress-induced ST-segment elevation, of whom 39 (19%) had no Q-wave MI in leads showing ST-segment elevation during either exercise (n = 31) or dipyridamole (n = 8) stress myocardial perfusion imaging. All 39 patients were hospitalized and underwent coronary angiography.


RESULTS
Significant coronary artery disease was found in all 39 patients: 87% had critical (>or=90%) stenosis, and 59% had multiple vessel disease. During hospitalization, 37 patients (95%) underwent revascularization.


CONCLUSIONS
In patients without prior Q-wave MI, stress-induced ST-segment elevation is associated with critical coronary artery disease. Therefore, these patients should be considered for early coronary investigation.
Beinart
Roy
R
Heart Institute, Chaim Sheba Medical Center, 52 621 Tel HaShomer, Israel.
Matetzky
Shlomi
S
Shechter
Michael
M
Fefer
Paul
P
Rozen
Eli
E
Beinart
Tal
T
Hod
Hanoch
H
Chouraqui
Pierre
P
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity