Precordial ST Segment Depression on Admission Electrocardiogram as a Simple Noninvasive Tool for Predicting Coronary Artery Disease Complexity in Patients with Inferior Myocardial Infarction

Author : J. Suganti, A. C. Lubis, A. A. Siregar, A. Sitepu, C. A. Andra, A. N. Nasution, H. Hasan
Upload Date : 19-04-2018

Background: The mechanism underlying precordial ST segment depression (PSTD) in inferior myocardial infarction (IMI) remains unclear. Previous studies suggested that PSTD in IMI was associated with a higher incidence of multivessel coronary artery disease (MVCAD) and it spesifically represents a concomitant anterior ischemia due to left anterior descending artery (LAD) disease. Therefore, the aim of this study is to analyze the complexity of coronary artery disease (CAD) in IMI patients with PSTD and to investigate whether PSTD in IMI can be used as a predictor of MVCAD.

Methods: A retrospective study was conducted on IMI patients who underwent coronary angiography during hospitalization at Cardiology Department Haji Adam Malik General Hospital between December 2013 and December 2016. Patients were divided into two groups based on the presence of PSTD on admission ECG. The complexity of CAD was analyzed using visualization and SYNTAX score. Bivariate and multivariate analysis were performed to study the association between PSTD and complexity of CAD.

Results: A total of 215 patients with IMI were found in this study period, with 102 patients meet the inclusion and exclusion criteria. The incidence of MVCAD, particularly LAD disease and SYNTAX score were higher in patients with PSTD than without PSTD (66% vs 34%; p<0.001; OR 4.696; 95% CI 1.923 to 11.463); (72% vs 28%; p<0.001; OR 5.674; 95% CI 2.412 to 13.350); and (20±12 vs 10±7; p<0.001). A further analysis with logistic regression model revealed that IMI patients with PSTD had a 4-fold increased risk of MVCAD than patients without PSTD (OR 4.097; 95% CI 1.638 to 10.247; p=0.003).

Conclusion: In daily clinical practice, PSTD on admission ECG may serves as a simple noninvasive tool for predicting MVCAD or a more complex CAD in IMI patients.

KEYWORDS : Precordial ST Segment depression, inferior myocardial infarction, multivessel coronary artery disease, SYNTAX score.

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