Abstract

PURPOSES
Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention.
BASIC PROCEDURE
We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65).
MAIN FINDINGS
Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I (P = .046).
PRINCIPAL CONCLUSIONS
The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.

Links

Publisher Full Text

Authors

Chen TE, Lo PH, Li TC, Lin KH, Lin JJ, Hsieh LC, Chang CP, Chen YP, Chang KC, Wang HJ

Institution

Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Source

The American journal of emergency medicine 30:9 2012 Nov pg 1865-71

MeSH

Blood Pressure
Cardiopulmonary Resuscitation
Coronary Angiography
Electrocardiography
Emergency Service, Hospital
Female
Heart
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction
Prognosis
Retrospective Studies
Tachycardia, Ventricular
Treatment Outcome
Troponin I

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22633733