Abstract 1999: Angiographic and Clinical Outcomes Among Patients with Acute Coronary Syndrome Presenting with Isolated Anterior ST-Segment Depressions
Background: Isolated ST-segment depression in the anterior precordial leads may be the result of either
unstable angina (UA)
anterior non-ST-segment elevation myocardial infarction (NSTEMI) or
The goal of this analysis was to determine the angiographic and clinical outcomes among patients presenting with acutge coronary syndrome (ACS) and isolated anterior ST-segment depression.
Methods: TRITON-TIMI 38 enrolled 13,608 patients with moderate- to high-risk ACS undergoing PCI. The association between isolated anterior ST-segment depression and epicardial flow in the culprit artery treated with PCI and clinical outcomes was assessed. ECGs and angiograms were interpreted locally by the enrolling physician.
Results: There were 1,198 patients with isolated anterior ST-segment depression: 314 (26.2%) had an occluded infarct-related artery (IRA) (TFG 0/1) and positive troponin (posterior STEMI), 641 (53.5 %) had a patent IRA (TFG 2/3) and positive troponin (NSTEMI), and 243 (20.3%) had TFG 2/3 and negative troponin (UA). Among patients with a posterior STEMI, the occluded artery was most often the left circumflex (48.4%, n=152). The 30-day incidence of the composite of death and MI was significantly higher among patients with posterior STEMI than among those with NSTEMI or UA (8.6%, 6.3% and 2.9%, respectively, 3-way p=0.006). Among patients with posterior STEMI, only 14 (4.5%) were interpreted by the investigator as STEMI, and the median time from ECG to PCI was 29.3 hours (IQR 26.1– 44.1 hours). Only 1 patient had an ECG-to-PCI time <2 hours, and 5 had an ECG-to-PCI time <6 hours.
Conclusion: Among patients presenting with chest pain and isolated anterior ST-segment depression, more than a quarter had posterior STEMI. Patients with an occluded artery at angiography had a significantly higher incidence of death and MI compared to those with NSTEMI or UA. Few such patients underwent PCI urgently, suggesting that further efforts are warranted to identify patients with isolated anterior ST-segment depression who have a posterior STEMI.