Serum phosphate in acute myocardial infarction.

The aim of this study is to measure phosphate levels in AMI, compare and analyse its relation with left ventricular (LV) dysfunction and mortality. Serum phosphate was measured by kinetic assay method in 40 patients with acute myocardial infarction (AMI). Echocardiographic LV function was assessed in all and the patients were followed up for 30 days. Hypophosphatemia (< 2.5 mg/dl) was observed in 27% of AMI patients (11/40). These patients formed group 1 of our study. The rest 73% patients (29/40) with normal phosphate levels formed group 2. Mean Phosphate level in group 1 was 1.96 mg/dl (range 1.2-2.37) and mean ejection fraction (EF) was .35 (range .25-.50, p value < .001). Mean phosphate in group 2 was 3.693 (range 2.6-6.00) and mean EF was .53 (range .38-.65, p value < .001). In hospital mortality of the group 1 was 28% (3/11) while in group 2 was 6.8% (2/29). We conclude hypophosphatemia in AMI is associated with LV dysfunction which results in increased 30 day mortality.

Angiographic correlates of anterior ST segment depression in acute inferior wall myocardial infarction.

This study was conducted prospectively to assess the correlation between the pattern of anterior ST segment depression on the admission electrocardiogram and the in-hospital morbidity and mortality in patients with acute inferior wall myocardial infarction. Coronary angiography was also done to assess its correlation, if any, with pattern of anterior ST segment depression. Our study cohort comprised of 165 consecutive patients with acute inferior wall myocardial infarction divided into four groups based on admission electrocardiogram. Group I (n = 33): patients with no anterior ST segment depression; group II (n = 16): patients with ST segment depression in leads V1-V3; group III (n = 71): patients with ST segment depression in leads V4-V6, I and aVF, and; group IV (n = 45): patients with ST segment depression in all anterior leads (V1-V6, I, aVL). The outcomes were analysed in terms of high grade atrioventricular block, Killip class II or higher failure, and in-hospital mortality. Coronary angiography was performed to analyse coronary anatomy. Group IV patients had increased incidence of complete heart block (37.8% vs 15.2% in the total group) (p < 0.001) and increased mortality (11.1% vs 4.2% in the total group) (p < 0.05). This group also had greater incidence of triple vessel disease (76.7%) (p < 0.001). Group II patients had greater incidence of double vessel disease (88.9%) (p < 0.05) and had no triple vessel disease. Group III patients had double vessel disease (76.5%) (p < 0.05) or triple vessel disease (23.5%) (p = NS) and no single vessel disease. Coronary angiography in group II showed greater incidence of involvement of left circumflex artery and right coronary artery while in group III there was left anterior descending artery and right coronary artery disease. We conclude that patients with anterior ST segment depression in group III and group IV categories are in high risk subset with acute inferior wall myocardial infarction.