Acute Inferior Wall Myocardial Infarction: High Risk Groups Identification According with Depression in the Precordial Leads

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Abstract

Background

In patients with acute inferior wall myocardial infarction, the presence of precordial ST segment depression was associated with a poor prognosis; previous studies have not distinguished about the site of precordial ST depression.

Method

We examined the medical charts of 213 consecutive patients with an inferior wall myocardial infarction and an initial electrocardiogram that displayed peaked tall T waves and/or ST segment elevation with upright T waves in inferior leads. Patients were classified into 3 types: group I, no ST segment depression; group II, sum of ST segment depression in leads V1-V3 equal or more than the sum of ST segment depression in leads V4-V6; and group III, maximal pre cordial ST segment depression in leads V4-V6-

Results

Thirty-six patients (17%) died in the hospital. In-hospital mortality rates for patients with type I and II were 12% and 10% respectively, compared with41% for those with type III (p < 0.0001). Multivariate logistic regression models for in-hospital mortality by ST-segment depression type adjusted for age, previous myocardial infarction, diabetes mellitus, and thrombolytic therapy revealed that type III pattern was a strong predictive factor for in-hospital mortality(odds ratio4.9, p = 0.0008,95% CI 1,93-12.26).

Conclusions

Patients with inferior wall myocardial infarction and maximal precordial ST segment depression in leads V4-V6 are at high risk for in-hospital mortality.