title: Prevalence and Clinical Significance of Up-Sloping ST-Segment Depression in Patients With Non-ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  Up-sloping ST-segment depression has not been historically considered as representing ischemia as this electrocardiographic change can be seen in normal subjects during exercise stress testing or tachycardia. We aimed to clarify the prevalence and clinical significance of up-sloping ST-segment depression in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  We performed a retrospective analysis of 330 consecutive patients with NSTEMI who underwent coronary angiography. ST-segment depression ≥ 0.05 mV in more than two contiguous leads was recorded and categorized as being up-sloping or non-up-sloping.
  
  
  RESULTS
  Of 330 patients, 109 patients (33%) had ST-segment depression; six of these patients had up-sloping ST-segment depression. All six patients with up-sloping ST-segment depression had a culprit lesion and underwent in-hospital revascularization. Three of these six patients had a culprit lesion in the left anterior descending artery; the culprit lesion in two others was in the left circumflex artery, while one patient had severe three-vessel disease. No statistically significant difference was found in the rate of in-hospital revascularization between patients with up-sloping and non-up-sloping ST-segment depression (100% vs. 75%, P = 0.33).
  
  
  CONCLUSIONS
  Patients with up-sloping ST-segment depression had a comparable rate of in-hospital revascularization compared to those with non-up-sloping ST-segment depression, suggesting that up-sloping ST-segment depression should be recognized as a manifestation of ischemia in NSTEMI.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, USA.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel Hospital, New York, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Schweitzer
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel Hospital, New York, USA.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
keywords: Electrocardiogram; Non-ST-segment elevation myocardial infarction; Up-sloping ST-segment depression