Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy

  • Aldino Satria Adhitya
  • Andika Sitepu
  • Zulfikri Mukhtar
  • Harris Hasan
DOI: https://doi.org/10.30701/ijc.v39i2.735

Abstract

Background: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. 

Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.

Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].

Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.

Keywords: Resolution in STSD, MACE, STEMI, Fibrinolytic

Downloads

Download data is not yet available.

References

1. Arso IA. Kejadian Kardiovaskular Mayor Pada Penderita Infark Miokard Akut Dengan Elevasi Segment ST (IMAEST) Yang Dilakukan Terapi Fibrinolitik Dibanding Intervensi Koroner Perkutan (IKP) Primer Selama Perawatan Di Rumah Sakit. Tesis Profesi Ilmu Penyakit Jantung dan Pembuluh Darah FK UGM. 2012.
2. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman Tatalaksana Sindrom Koroner Akut. Edisi Ketiga. Centra Communications. 2014.
3. Steg G, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segmen elevation. European Heart Journal. 2012;2012:1-51.
4. Sarahazti MF. Global Longitudinal Strain (GLS) ventrikel kiri sebagai prediktor kejadian kardiovaskular mayor dalam 30 hari setelah infark miokard akut elevasi segmen ST di Rumah Sakit Haji Adam Malik Medan. Tesis Profesi Ilmu Penyakit Jantung dan Pembuluh Darah FK USU. 2017.
5. Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgard Med J. 2003; 79:490-504.
6. Zimetbaum PJ, Josephson ME. Use of Electrocardiogram in Acute Myocardial Infraction. The New England Journal Of Medicine. 2003;348:933-40.
7. The Lancet. Reciprocal Changes Accompanying Acute Myocardial Infarction. Lancet. 1986:1370-1371.
8. Noriega FJ, Jorge E, Arzamendi D, et al. Mechanism and diagnostic potential of reciprocal ECG changes induced by acute coronary occlusion in pigs. Journal of Heart Rhythm. 2013:10:883-90.
9. Ferguson DW, Pandian N, Kioschos JM, et al. Angiographic evidence that reciprocal ST-segment depression during acute myocardial infarction does not indicate remote ischemia : Analysis of 23 patient. The American Journal of Cardiology. 1984;53(1):55-62.
10. Katz R, Conroy RM, Robinson K et al. The aetiology and prognostic implications of reciprocal electrocardiographic changes in acute myocardial infraction. Br Heart J. 1986;55:423-7.
11. Rude RE, Croft CH, Willerson JT. “Reciprocal” anterior ST depression early in the course of transmural inferior myocardial infarction: an ECG finding of uncertain clinical significance. International Journal of Cardiology. 1983;4:80-85.
12. Berger PB, Ryan TJ. Inferior myocardial infraction: high-risk subgroups. Circulation. 1990;81:401-411.
13. Jennings K, Reid DS, Julian DG. “Reciprocal” depresision of ST segment in acute myocardial infarction. Br Med J. 1983;287:634-637.
14. Gelman JS, Saltrup A. Pericordial ST depression in pateients with inferior infarction: clinical implications. Br Heart J. 1982;7:133-139.
15. Herlitz J, Hjalmarson H. Occurence of Anterior ST depression in Inferior Myocardial Infarction and relation to clinical outcome. Clin Cardiol. 1987;(10):529-534.
16. Hasdai D, Sclarovsky S, Solodky A, et al. Prognostic significance of maximal pericordial ST segment depression in right (V1-V3) versus left (V4-V6) leads in patients with inferior wall acute myocardial infarction. The American Journal Cardiology. 1994;74(11):1081-1084.
17. Forfar JC. Reciprocal ST segment changes in acute myocardial infarction: informative or incidental?. Quarterly Journal of Medicine. 1989;72:763-765.
18. Stevenson RN, Ranjadayalan K, Umachandran V, et al. Significance of reciprocal ST depression in acute myocardial infarction: a study of 258 patients treated by thrombolysis. Br Heart J. 1993;69:211-214.
19. Buller CE, Fu Y, Adams P, et al. ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Insight From the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Trial. Circulation. 2008;118:1335-1346.
20. Suganti J. Perbandingan Kejadian Klinis Kardiovaskular Mayor Selama Perawatan di Rumah Sakit Pada Penderita Infark Miokard Akut Elevasi Segment ST Inferior dengan dan Tanpa Depresi Segment ST Perikordial di Rumah Sakit Haji Adam Malik Medan. Tesis Magister Ilmu Penyakit Jantung dan Pembuluh Darah FK USU. 2016.
21. Wong CK, Gao W, White HD. Resolution of ST depression after fibrinolysis can be more important than resolution of ST elevation for many patients with inferior STEMIs. International Journal of Cardiology. 2015;182:232-234.
22. Antman EM. “ST-Segment Elevation Myocardial: Pathology, Pathophysiology and Clinical Features”. In: Braunwald E, Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier; 2012:1087-1111.
23. De Lemos JA, Braunwald E. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol. 2001;38:1283.
24. Angeja BG, Gunda M, Murphy SA, et al. TIMI myocardial perfusion grade and ST segment resolution: association with infarct size as assessed by single photon emission computed tomography. Circulation. 2002;105:282.
25. Hathaway WR, Peterson ED, Wagner GS, et al. Prognostic Significance of the Initial Electrocardiogram in Patients With Acute Myocardial Infarction. GUSTO-I Investigator. J of Am Med Association. 1998;279(5):387-391.
26. Peterson ED, Hathaway WR, Zabel KM, et al. Prognostic significance of pericordial ST Segment depression during inferior myocardial infarction in the thrombolytic era: results in 16.521 patients. J Am Coll Cardiol. 1996;28:305.
27. Birnbaum Y, Kloner RA, Sclarovsky S, et al. Distortion of the terminal portion of the QRS on the admission electrocardiogram in acute myocardial infarction and correlation with infarct size and long-term prognosis (TIMI-4 Trial). Am J Cardiol. 1999;78:396.
Published
2019-09-11
Views & Downloads
Abstract views: 9042   
PDF downloads: 3456   
How to Cite
Adhitya, A., Sitepu, A., Mukhtar, Z., & Hasan, H. (2019). Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy. Indonesian Journal of Cardiology, 39(2). https://doi.org/10.30701/ijc.v39i2.735
Issue
Vol 39 No 2 (2018): Indonesian Journal of Cardiology: April-June 2018
Section
Clinical Research

Copyright (c) 2019 Indonesian Journal of Cardiology

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    • Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
    • Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    • Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

Most read articles by the same author(s)