significance of reciprocal changes on electrocardiogram in acute myocardial infarction

Two hundred and fourteen patients admitted to the coronary care unit at Punjab Institute of Cardiology, Lahore with acute myocardial infarction [MI] were analysed of these, 130 had reciprocal ST segment depression and 84 did not have these changes. 46 [35.4%] patients with reciprocal ST segment depression and 14 [16.7%] without these developed left ventricular failure [P<.02]. The mortality was significantly higher in the group with reciprocal changes than without i.e. 21 patients [16%] versus 5 patients [5.9%] [P<.04]. The size of MI assessed by the peal levels of creative kinase [CK] was significantly larger in patients with reciprocal changes [2459 +/- 1611 IU/L] [% t S.Dl compared with 1542 +/- 123'7 IU/L for those without [P<.01], even when the anterior and inferior MI were analysed separately. The patients with no reciprocal changes developed significantly more non-Q MIs t. e 23 [27.4%] compared to 10 [7.7%] for those with reciprocal changes [P<.01]. We conclude that the patients with reciprocal segment depression on admission ECG develop more complications related to acute infarction. These patients should be aggressively treated