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Prognostic significance of the initial electrocardiographic pattern in patients with inferior wall acute myocardial infarction.
MedLine Citation:
PMID:  8903535     Owner:  NLM     Status:  MEDLINE    
The purpose of the study was to determine whether the initial electrocardiographic pattern is predictive of in-hospital mortality in inferior wall acute myocardial infarction. It is commonly perceived that patients with acute myocardial infarction presenting with greater ST elevation have a worse prognosis. The initial electrocardiogram of patients (n = 213) with inferior wall myocardial infarction was categorized based on the pattern of ST-segment elevation in inferior leads: (A) ST <1 mm with tall T waves, (B) ST > or = 1 mm with normal terminal QRS, and (C) ST > or = 1 mm with distortion of terminal QRS. ST deviation from baseline was calculated for all leads. Patients with maximal precordial ST depression in V4-V6 and pattern A had an in-hospital mortality rate of 68.8% compared with 16.9% for the entire study group. By univariate analysis, only pattern A was significantly predictive of in-hospital mortality [odds ratio = 2.91, 95% confidence interval (CI) 1.22-6.93], but by multivariate analysis adjusted for (1) age, (2) diabetes mellitus, (3) previous myocardial infarction, (4) thrombolytic therapy, (5) precordial ST-depression pattern, and (6) patterns of ST elevation, maximal ST depression in V4-V6 was significantly predictive (odds ratio = 4.93, 95% CI 1.79-13.56), whereas pattern A was not (odds ratio = 1.12, 95% CI 0.36-3.52). Contrary to popular perception, patients with inferior wall myocardial infarction presenting with minimal ST-segment elevation are at highest risk for in-hospital mortality, especially if accompanied by maximal precordial ST depression in V4-V6.
D Hasdai; S Sclarovsky; A Solodky; J Sulkes; Y Birnbaum
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  19     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1997-02-28     Completed Date:  1997-02-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  31-6     Citation Subset:  IM    
Department of Cardiology, Beilinson Medical Center and Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Coronary Care Units
Evaluation Studies as Topic
Follow-Up Studies
Hospital Mortality*
Logistic Models
Middle Aged
Myocardial Infarction / diagnosis*,  mortality,  pathology
Odds Ratio
Sensitivity and Specificity
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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