Angiographic evidence that reciprocal ST-segment depression during acute myocardial infarction does not indicate remote ischemia: Analysis of 23 patients

Although reciprocal ST-segment depression from the remote noninfarcting ventricular wall during acute myocardial infarction (Ml) is a common clinical finding, the significance of this electrocardiographic pattern is unclear. Previous retrospective studies have suggested that these findings may reflect either remote wall ischemia, multivessel coronary artery disease (CAD), extensive MI or a benign electrical phenomenon. Prior studies have lacked angiographic data obtained at the time of these acute electrocardiographic changes. In this study we prospectively evaluated 23 patients with acute MI. Left ventricular wall motion, coronary anatomy and the ECG were all assessed over a short period during the acute phase of the MI. Segmental wall motion was used as a sensitive indicator of ischemia.Seventeen patients had acute anterior MI, of whom 47 % had reciprocal ST-segment depression; 6 patients had inferior MI, with 3 showing reciprocal ST depression. The mean degree of ST-segment elevation from the infarcting wall tended to be greater in patients with reciprocal ST-segment depression than in those without such reciprocal ST depression (2.8 ± 0.4 vs 1.9 ± 0.3 mm, p = 0.06). Patients with and without reciprocal ST-segment depression had similar degrees of segmental dysfunction in the infarct wall. However, no abnormalities in segmental wall motion in the remote wall were seen regardless of the presence or absence of remote wall ST-segment depression. In addition, the presence or absence of ST-segment depression did not predict the extent or degree of CAD. Finally, the magnitude of ST-segment elevation from the acutely infarcting wall correlated significantly with the degree of remote wall reciprocal ST-segment depression (r = 0.83, p < 0.01).Thus, the presence of remote wall reciprocal ST-segment depression on the ECG during the acute phase of an MI does not predict ischemia or the extent of CAD in the arteries supplying the remote noninfarcting wall. Because the reciprocal electrocardiographic changes correlate with the degree of ST-segment elevation, they probably represent a benign electrical phenomenon.