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The significance of reciprocal ST segment depression (RSTD) during acute myocardial infarction has been an area of debate, whether it is a sign of multivessel disease, ischemia at a distance or merely a benign electrical phenomenon.
To Study the relationship between the presence of RSTD in ST elevation myocardial infarction (STEMI) and the extent of coronary artery disease & left ventricular systolic function.
The current study was conducted as a prospective, randomized, controlled single center study involving 200 STEMI patients (100 inferior STEMI, 100 anterior STEMI) admitted to the Critical Care Department, Cairo University in the period between January 2011 & January 2014. The studied patients were grouped into 2 groups (A anterior & B inferior STEMI),each group was sub-grouped into 2 subgroups according to the presence of RSTD in non-infarcted leads (A1, B1) or absence (A2, B2). Patients were subjected to echocardiographic assessment of LV systolic function (LVEF %) & coronary angiography to assess extent & severity of coronary artery disease using modified Gensini score (MGS).
In both anterior & inferior STEMI, patients with RSTD showed a statistically significant lower mean left ventricular ejection fraction (LVEF) compared to those without RSTD (37±3% vs 53±5% respectively, P< 0.001 in anterior STEMI) & (47±4% vs 60±3%, respectively, P< 0.001 in inferior STEMI).Higher incidence of multivessel disease was found in subgroups with RSTD (80.5% vs 49.2%, P< 0.001 in anterior STEMI) & (60% vs 20%, P< 0.001 in inferior STEMI). The mean MGS was significantly higher in subgroups with RSTD compared to those without RSTD (64.2±12.6 vs 30.2±6.6, P< 0.001 in anterior STMI)&(36.2±10.6 vs 20.4±4.2 ,p<0.001 in inferior STEMI). In anterior STEMI, patients with RSTD showed a statistically significant higher incidence of significant RCA lesions (75.6% vs 42.4%, P< 0.001) & LCX lesions (48.8% vs 27.1%, P value 0.023). Significant LAD lesions were significantly higher in inferior STEMI patients with RSTD (78% vs 24%, P< 0.001).
Reciprocal ST segment depression in non-infarcted leads in the setting of acute myocardial infarction (anterior or inferior) was associated with significant LV systolic dysfunction & greater extent of coronary artery disease.