Abstract 9408: ST-Segment Elevation in Leads V5-6 Predicts In-Hospital Adverse Outcomes in Patients With Reperfused Inferior Acute Myocardial Infarction
Introduction: In inferior wall acute myocardial infarction (IWMI), ST-segment elevation in leads V5-6 (STE V5-6) is often observed, but its prognostic impact is unclear.
Methods: We examined admission ECGs in 361 patients with a first IWMI who had TIMI 3 flow of the right coronary artery (RCA) or left circumflex artery (LCX) by reperfusion therapy within 6 hours after symptom onset. Patients were divided according to the presence (n=77) or absence (n=284) of STE V5-6 >2 mm, and the former was subdivided into the 2 groups according to the degree of STE in leads III and V6: STE:III>V6 (n=53) and STE:III≤V6 (n=24). The perfusion territory of the culprit artery was assessed by angiographic distribution score, and mega-artery was defined as a score ≥0.7.
Results: Age, sex, time to admission, reperfusion therapy, or time to reperfusion was similar in the 3 groups. STE V5-6 was associated with mega-artery occlusion, larger infarction, and in-hospital adverse events (death, reinfarction, or heart failure). RCA occlusion was most common in STE V5-6 with STE:III>V6, whereas LCX occlusion, especially proximal LCX occlusion, was most common in STE V5-6 with STE:III≤V6. In multivariate analysis, STE V5-6 with STE:III>V6 (OR 2.90, 95%CI 1.10-7.02, p<0.01) and that with STE:III≤V6 (OR 3.63, 95%CI 1.58-8.96, p<0.01) were independent predictors of in-hospital adverse events.
Conclusions: In reperfused IWMI, ST-segment elevation in leads V5-6 on admission ECG strongly predicts in-hospital adverse outcomes; furthermore, comparing the degree of ST-segment elevation in leads III and V6 is useful for predicting the culprit artery (i.e., RCA or LCX).
Author Disclosures: M. Kosuge: None. T. Ebina: None. K. Hibi: None. K. Tsukahara: None. N. Iwahashi: None. N. Maejima: None. E. Akiyama: None. S. Umemura: Research Grant; Modest; Torii. Research Grant; Significant; Pfizer, Dainippon-Sumitomo, Astellas, Shionogi, Daiichi-Sankyo, MSD, Astrazeneca, Novartis, Nihon-Boehringer-Ingelheim. Honoraria; Modest; Shionogi, MSD, Kyowa-Hakko-Kirin. K. Kimura: Research Grant; Significant; Toa Eiyo Ltd, Bayer, MSD, Astellas, Astrazeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Otsuka, Novartis, Pfizer, Shionogi, Kowa-souyaku, Daiichi-Sankyo, Mitsubishi Tanabe, Nihon-Boehringer-Ingelheim, Takeda, Ono. Honoraria; Modest; Astrazeneca. Honoraria; Significant; MSD.
- © 2014 by American Heart Association, Inc.