title: Influence of the extent of coronary atherosclerotic disease on ST-segment changes induced by ST elevation myocardial infarction.
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 V1 to V5, 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 V2 and V3. ST-segment elevation in lead V6 >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.
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: fnoriega@santpau.cat.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Noriega
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Vives-Borrás
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Solé-González
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: García-Picart
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology*; D054059:Coronary Occlusion / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D020107:Troponin T; D003402:Creatine Kinase