1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

ST-SEGMENT DEPRESSION IN MI SIGNALS DANGER.

Which patients who survive acute myocardial infarction can expect to live for at least a year? Data from the Multicenter Diltiazem Postinfarction Trial suggest that patients with ST-segment depression on their electrocardiograms have a worse prognosis.

Researchers reviewed ECGs obtained in the coronary care unit for 1234 patients with acute MI who survived this phase of care. Of these patients, 338 had non-Q-wave MI. Overall, patients with evidence of ST-segment depression (about half the sample) had an odds ratio of 1.9 for death during the next year as compared to patients without this finding. Mortality ranged from 10.4 percent to 11.5 percent in patients with lateral, inferior, or anterior ST depression, but was only 6.7 percent in patients with posterior changes and only 5.6 percent in those without ST depression. ST depression was an ominous finding in patients with or without Q-wave infarction, and independently predicted death in a multivariate analysis.

Comment: The worse prognosis in patients with ST-segment depression during acute MI may reflect more severe coronary disease and more myocardium in jeopardy. These patients may warrant more aggressive evaluation, and should be considered for coronary angiography and revascularization.

— THL

Published in Journal Watch General Medicine August 27, 1993

Citation(s):

Krone RJ et al. Long-term prognostic significance of ST segment depression during acute myocardial infarction. J Am Coll Cardiol 1993 Aug 22 361-367.

• Medline abstract (Free)