Correlation of Sum of ST Segment Depression in Leads V1 to V4 in Acute Inferior Myocardial Infarction with Angiographic Severity of Coronary Artery Disease

Bangladesh Heart Journal Pub Date : 2022-12-28 DOI:10.3329/bhj.v37i2.63135

M. Badiuzzaman, Afk Ahmed, Mohammad Refatul Islam, Md Durul Hoda, Abdur Rashid, F. Ahmed, Iftekhar Alam

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Abstract

Background: Inferior wall acute myocardial infarction accounts for 40 to 50% of all acute STEMI. Patients of acute inferior myocardial infarction with ST depression in lateral leads often have greater incidence of triple vessel disease and proximal RCA lesion but in case of patients of acute inferior myocardial infarction with ST depression in precordial leads (leads V1 to V4), is a subject of determination whether it is associated with more sever coronary artery disease. The aim of this study is to determine the association of sum of ST depression in precordial leads with the probability of concomitant severity of coronary artery disease in patients with acute inferior STEMI. Methods: this cross sectional observational study was done at National institute of cardiovascular diseases (NICVD), Dhaka, Bangladesh. Total 90 patients of acute inferior myocardial infarction with precordial lead ST depression admitted at CCU within 12 hours of onset of chest pain were the study population. They were divided in two groups on the basis of sum of ST depression in precordial leads (Sum of ST depression d”4mm and >4mm), 36 patients in group I and 54 patients in group II. Coronary angiography was performed during the index hospitalization period. Gensini score and Reardon score were measured. Results: Overwhelming majority of the patients was male (83.3% and 90.7%) with mean age of 51.0±9.7 and 51.0±9.9 years in group I and II respectively. Smoking, hypertension and diabetes mellitus were the most frequent risk factors in both groups. Serum troponin level was significantly high in group II (6.2±2.2 vs. 13.6±17.7, p <0.05). Sum of ST depression in precordial leads was 2.84±0.66 and 7.53±3.51 in group I and group II respectively, and was statistically significant. Consideration of mean of ST depression in individual leads shows significantly higher mean in leads V2, V3 and V4 among group II patients. SVD was more frequent in group I but group II patients had higher statistically significant incidence of DVD and TVD. Gensini score (20.26±13.0 vs. 36.98±16.9) and Reardon score (4.63±2.2 vs. 6.83±2.2) was high in group II patients. Positive correlation had been depicted between summation value of ST segment depression with that of Gensini score & Reardon score (Gensini score r=0.61 and Reardon score r= 0.52). Conclusion: Involvement Triple vessel and double vessel disease was remarkably higher with increasing sum of ST segment depression in precordial leads. The severity of ST segment depression in terms of summation of ST depression in leads V1 to V4 is directly proportional to the extent and severity of coronary artery disease. Bangladesh Heart Journal 2022; 37(2): 116-121

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急性下壁心肌梗死V1 ~ V4导联ST段下降总和与冠状动脉病变严重程度的相关性

背景:急性下壁心肌梗死占所有急性STEMI的40 - 50%。急性下壁心肌梗死伴外侧导联ST段压低的患者，其三支血管病变及近端RCA病变的发生率往往更高，但急性下壁心肌梗死伴心前导联ST段压低(V1至V4导联)的患者是否与更严重的冠状动脉病变相关，尚有待确定。本研究的目的是确定急性下段STEMI患者心前导联ST段下降与冠状动脉疾病严重程度的相关性。方法:本横断面观察性研究在孟加拉国达卡国立心血管疾病研究所(NICVD)完成。共有90例急性下壁心肌梗死伴心前导联ST段抑制的患者在胸痛发作后12小时内入住CCU。根据心前导联ST段压降之和(ST段压降之和d”4mm和>4mm)分为两组，I组36例，II组54例。在指数住院期间行冠状动脉造影。测量Gensini评分和Reardon评分。结果:ⅰ组和ⅱ组患者以男性占绝大多数(83.3%和90.7%)，平均年龄分别为51.0±9.7和51.0±9.9岁。吸烟、高血压和糖尿病是两组中最常见的危险因素。II组血清肌钙蛋白水平显著高于对照组(6.2±2.2∶13.6±17.7,p <0.05)。ⅰ组和ⅱ组心前导联ST段压降总分分别为2.84±0.66和7.53±3.51，差异有统计学意义。考虑单个导联ST段压降的平均值，II组患者V2、V3和V4导联的平均值明显较高。SVD在I组发生率更高，而DVD和TVD在II组发生率更高，具有统计学意义。Gensini评分(20.26±13.0比36.98±16.9)和Reardon评分(4.63±2.2比6.83±2.2)较高。ST段凹陷的总和与Gensini评分和Reardon评分呈正相关(Gensini评分r=0.61, Reardon评分r= 0.52)。结论:随着心前导联ST段压低量的增加，累及三支及双支病变的发生率明显增高。从V1至V4导联ST段压降的总和来看，ST段压降的严重程度与冠状动脉病变的程度和严重程度成正比。孟加拉国心脏杂志2022;37 (2): 116 - 121

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Bangladesh Heart Journal

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