790-5 Prognostic Significance of Different Patterns of Precordial ST Segment Depression in Inferior Wall Acute Myocardial Infarction

Previous studies have shown that ST depression in the precordial leads in inferior wall acute myocardial infarction (lAMI) is associated with increased in hospital mortality. However, no distinction has been made between maximal ST depression in the right versus left precordial leads. This study assesses the correlation between the pattern of precordial ST depression in the admission ECG and 30-day mortality in 1321 pts with IAMI. All pts were admitted within 6 hours from onset of symptoms and received either STK or tPA intravenously. Only pts with ST elevation ≥ 0.1 mV and positive T waves in at least two of the inferior leads were included. Pts were allocated into 4 groups: group A-no precordial ST depression (n = 346); group B-sum of ST depression in right leads (VI-V3) greater than the sum in left leads (V4–V6) (n = 700); group C-surn of ST depression in right leads equal to the surn in left leads (n = 162); and group D-rnaximal ST depression in V4–V6(n = 113). A total of 48 pts (3.6%) died. The mortality for group A, B, C, and D were 10 (2.9%), 20 (2.8%), 7 (4.3%), and 11 (9.7%), respectively. Using logistic regression model, only the following parameters were found to be independent predictors for 30-days mortality; Odds Ratio 95% Confidence Interval Sex (Females vs. Males) 2.39 1.15-4.94 Age (years): (60-69 vs. l60) 3.42 0.89-13.1     ( ≥ 70 vs. l 60) 13.4 3.85-46.3 Previous Myocardial Infarction 2.33 1.11-4.89 Diabetes Mellitus 1.95 0.92-4.12 Killip on Admission ( g 1vs. 1) 2.99 1.48-6.04 Peak CK Level (per 1000 IU) 1.28 1.02-1.61 Group B versus Group A 0.85 0.32-2.27 Group Cversus Group A 1.72 0.55-5.37 Group D versus Group A 2.84 0.94-8.59 Conclusions pts with IAMI and maximal ST depression in left precordial leads in the admission ECG, are at high risk for 3D-day mortality, while ST depression in the right precordial leads (Vl–V3) is not associated with increased risk.