Correlation of Angiographic findings and Right [V1 - V3] versus left [V4 -V6] pre-cordial ST segmen depression in acute inferior wall myocardial infarction

ABSTRACT

Studies shows that ST depression in leads V1-V3 is generally believed to be associated with larger acute myocardial infarction and worser left ventricular function. Several studies have suggested that ST depression in V4-V6 confers a higher incidence of concomitant left anterior descending artery or multivessel disease. This study was performed to study the correlation between angiographic findings in form of affection of left anterior descending artery or number of vessels affected and Rt [V1]-V3] versus left [V4-V6] precordial ST segment depression in patients with acute inferior wall myocardial infarction. The study included 60 patients with 1[st] time acute inferior myocardial infarction. All of them received strep-tokinase [IV]. Resting EGG, serum cardiac enzymes and coronary angiography was done to all patients. We compared the data between patients with no ST depression in precordial leads and patients with ST depression in RT [V1-V3] precordial leads and patients with ST depression in left [V4-V6] precordial leads .The LVEF was significantly lower in patients with ST depression in left leads [p < 0.05] Significant LAD lesion was more in the same group [P < 0.01]. This group also showed higher incidence of three vessel disease [P < 0.01]. The mean peak CK level was higher in patients with ST depression in Right leads [P < 0.01]. So we concluded that patients with inferior wall myocardial infarction with no ST depression in precordial leads runs a benign course with low enzymatic release, normal ejection fraction, single vessel disease. Patients with Right precordial leads ST depression is characterized by high enzymatic release in comparison with patients with left precordial leads ST depression who show an aggressive course with low ejection fraction, multivessel disease, and more LAD artery affection. Thus we recommend that more attention should be paid to EGG analysis since this may affect the treatment strategy