Document Detail

Prognostic value of lead V1 ST elevation during acute inferior myocardial infarction.
MedLine Citation:
PMID:  20644020     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Lead V(1) directly faces the right ventricle and may exhibit ST elevation during an acute inferior myocardial infarction when the right ventricle is also involved. Leads V(1) and V(3) indirectly face the posterolateral left ventricle, and ST depression ("mirror-image" ST elevation) in V(1) through V(3) may reflect concomitant posterolateral infarction. The prognostic significance of V(1) ST elevation during an acute inferior myocardial infarction may therefore be dependent on V(3) ST changes. METHODS AND RESULTS: In 7967 patients with acute inferior myocardial infarction in the Hirulog and Early Reperfusion or Occlusion-2 (HERO-2) trial, V(1) ST levels were analyzed with adjustment for lead V(3) ST level for predicting 30-day mortality. V(1) ST elevation at baseline, analyzed as a continuous variable, was associated with higher mortality. Unadjusted, each 0.5-mm-step increase in ST level above the isoelectric level was associated with approximately 25% increase in 30-day mortality; this was true whether V(3) ST depression was present or not. The odds ratio for mortality was 1.21 (95% confidence interval, 1.07 to 1.37) after adjustment for inferolateral ST elevation and clinical factors and 1.24 (95% confidence interval, 1.09 to 1.40) if also adjusted for V(3) ST level. In contrast, lead V(1) ST depression was not associated with mortality after adjustment for V(3) ST level. V(1) ST elevation >or=1 mm, analyzed dichotomously in all patients, was associated with higher mortality. The odds ratio was 1.28 (95% confidence interval, 1.01 to 1.61) unadjusted, 1.51 (95% confidence interval, 1.19 to 1.92) adjusted for V(3) ST level, and 1.35 (95% confidence interval, 1.04 to 1.76) adjusted for ECG and clinical factors. Persistence of V(1) ST elevation >or=1 mm 60 minutes after fibrinolysis was associated with higher mortality (10.8% versus 5.5%, P=0.001). CONCLUSIONS: V(1) ST elevation identifies patients with acute inferior myocardial infarction who are at higher risk.
Cheuk-Kit Wong; Wanzhen Gao; Ralph A Stewart; John K French; Philip E Aylward; Jocelyne Benatar; Harvey D White;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-07-19
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-03     Completed Date:  2010-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  463-9     Citation Subset:  AIM; IM    
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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MeSH Terms
Anterior Wall Myocardial Infarction* / diagnosis,  drug therapy,  mortality
Anticoagulants / therapeutic use
Aspirin / therapeutic use
Bundle-Branch Block / diagnosis,  mortality
Drug Therapy, Combination
Electrocardiogram Pattern*
Fibrinolytic Agents / therapeutic use*
Heparin / therapeutic use
Middle Aged
Peptide Fragments / therapeutic use*
Predictive Value of Tests
Recombinant Proteins / therapeutic use
Risk Factors
Streptokinase / therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.-/Streptokinase

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