The prognosis of Different Types of Reciprocal ST-segment Depression (R-ST-D) on Electrocardiograms in Acute Myocardial Infarction

Background: We investigated how to define the culprit coronary artery according to different reciprocal ST-segment depression (R-ST-D) types on electrocardiograms in ST-segment elevation acute myocardial infarction (STEMI), as well as the high-risk factors. Methods: To analyze the prognosis of different R-ST-D types to define the culprit coronary artery and high-risk factors, 967 patients with STEMI were included and divided into four groups according to STEMI infarction sites and R-ST-D type: group I (type I), without R-ST-D (n = 143); group II (type II), R-ST-D less than or equal to the amplitude of ST-segment elevation (n = 664); group III (type III), R-ST-D greater than or equal to the amplitude of ST-segment elevation (n = 93); and group IV (type IV), the amplitudes of R-ST-D and ST-segment elevation were both elevated (n = 67). Results: The incidence of type II was the highest at 68.7%, followed by that of type I, which was mainly due to anterior descending branch stenosis. Type IV was mainly caused by complete occlusion of multiple vessels including the anterior descending branch and circumflex branch and/or right coronary artery. Type III was always related to a higher incidence of malignant complications, ventricular wall motion disorders, and ejection fraction index <= 50% compared with types I and II (p < 0.05 and p < 0.01, respectively). Conclusion: Different high-risk stratifications of R-ST-D in patients with STEMI, especially type III and IV, can be used as objective independent indices to predict and assess the culprit coronary artery and life-threatening prognosis. Copyright (C) 2018, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC.