Myocardial infarction: inferior: ST depression in the limb leads on admission ECG increased the risk of dying.

Clinical bottom line (level 2b)

  1. 4% of patients with an inferior myocardial infarction were dead within 30 days.
  2. The risk of dying was increased with ST depression in leads V 1 to V 6 on admission ECG.
Peterson et al: Journal of the American College of Cardiology 1996; 28 (2): 305-312
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospitals, USA and Europe

16521 patients (aged mean 61, ~73% male) with inferior myocardial infarction on admission ECG

Excluded if
  • left bundle branch block, paced rhythm or uninterpretable ECG
  • prior Q wave infarction



    • Factors studied:
  • age, systolic blood pressure, Killip class, heart rate, prior infarction, height, weight, cardiovascular risk factors, prior bypass surgery, known cerebrovascular disease


    • All patients received thrombolysis, and the majority had aspirin and nitrates.

    Logistic regression analysis was used to adjust for confounding factors.

    ?100% followed for 30 days
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 30 days 727/16521 4.4%
    (4.1% to 4.7%)    		 23
    (21 to 24)

    • Increased mortality was independently associated with
      • precordial ST segment depression
      No other ECG features were clearly associated with mortality.

    Comments

    1. ST segment depression was not found to be correlated to reinfarction or stroke.
    2. No odds ratios were reported.
    3. Patients were from a randomised controlled trial comparing different thrombolytic regimens.

    Citation

    1. Peterson ED, Hathaway WR, Zabel KM, et al: Prognostic significance of precordial ST segment depression during inferior myocardial infarction in the thrombolytic era: results in 16,521 patients. Journal of the American College of Cardiology 1996; 28 (2): 305-312
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient inferior myocardial infarction
    Intervention or Exposure precordial ST segment depression
    Outcome death