Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)
| Autor: | Jesse A. Kane, Kristen E. Meyers, Daniel Lee, Alexander Bracey, Zach Rollins, Stephen W. Smith, Wei J. Li, Andrew Lichtenheld, Daniel D. Singer, H. Pendell Meyers, Kenneth W. Dodd, Gautam R. Shroff, Adam J. Singer |
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| Rok vydání: | 2021 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty medicine.medical_treatment Population non–ST‐segment–elevation myocardial infarction Myocardial Infarction posterior myocardial infarction Risk Assessment Internal medicine medicine ST‐segment elevation myocardial infarction ST segment Diseases of the circulatory (Cardiovascular) system Humans acute coronary syndromes Myocardial infarction cardiovascular diseases Acute Coronary Syndrome education Retrospective Studies education.field_of_study Troponin T business.industry occlusion myocardial infarction Percutaneous coronary intervention Thrombolysis medicine.disease RC666-701 Cardiology ST Elevation Myocardial Infarction ST‐segment depression Cardiology and Cardiovascular Medicine business TIMI |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 23 (2021) |
| ISSN: | 2047-9980 |
| Popis: | Background Occlusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST‐segment–elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST‐segment depression maximal in leads V1–V4 (STDmaxV1–4) has been suggested as an indicator of posterior OMI. Methods and Results We retrospectively reviewed a high‐risk population with acute coronary syndrome. OMI was defined from prior studies as a culprit lesion with TIMI (Thrombolysis in Myocardial Infarction) 0 to 2 flow or TIMI 3 flow plus peak troponin T >1.0 ng/mL or troponin I >10 ng/mL. STEMI was defined by the Fourth Universal Definition of Myocardial Infarction. ECGs were interpreted blinded to outcomes. Among 808 patients, there were 265 OMIs, 108 (41%) meeting STEMI criteria. A total of 118 (15%) patients had “suspected ischemic” STDmaxV1–4, of whom 106 (90%) had an acute culprit lesion, 99 (84%) had OMI, and 95 (81%) underwent percutaneous coronary intervention. Suspected ischemic STDmaxV1–4 had 97% specificity and 37% sensitivity for OMI. Of the 99 OMIs detected by STDmaxV1–4, 34% had P =0.028). Conclusions Among patients with high‐risk acute coronary syndrome, the specificity of ischemic STDmaxV1–4 was 97% for OMI and 96% for OMI requiring emergent percutaneous coronary intervention. STEMI criteria missed half of OMIs detected by STDmaxV1–4. Ischemic STDmaxV1–V4 in acute coronary syndrome should be considered OMI until proven otherwise. |
| Databáze: | OpenAIRE |
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