Status of Emergent Reperfusion Therapy in Patients with Acute Coronary Syndrome Having ST Depression in Right Precordial Leads with Non-Reassuring ST Elevation in Posterior Leads
DOI:
https://doi.org/10.48047/Keywords:
LVF, MR, Occlusion, Posterior wall MI, posterior leads, Right anterior precordial leads.Abstract
Background: ST depression in right pre-cordial leads is the most common under-diagnosed and
untreated infarction pattern of isolated posterior wall myocardial infarction (PMI). Guidelines
emphasizes to treat above electrocardiographic changes in patients with acute coronary
syndrome(ACS) with emergent reperfusion therapy, after confirming the same as posterior wall
MI, detecting ST elevation (≥0.5 mm) in two or more posterior leads. However ST elevation may
not be manifested in Posterior leads in some cases of PMI due to damping of electrical signals
arising from posterior aspect of the heart by air of lungs.
Objective: To evaluate clinico-angiographic profile and outcomes of patients with ACS having
ST depression in anterior leads with non-reassuring ST elevation in posterior leads
Methods: Total 32 hospitalised patients with Acute Coronary Syndrome having horizontal or
down sloping ST-depression (≥0.5 mm in two or more leads) in leads V1,V2,V3 without ST
elevation (≥ 0.5mm in two or more leads) in posterior leads were finalised as study participants.
Data about clinical, echocardiographic and angiographic findings were studied.
Results: Prevalence of mitral regurgitation, left ventricular failure and mortality is very high i.e
71.8%, 43.7%, 12.4% among patients respectively. Regional wall motion abnormality in the
posterior wall observed invariably in all the patients. All the patients found to have total or
subtotal occlusion of either RCA or LCX representing PMI.
Conclusion: ST depression in right precordial lead in patients with ACS most often represents
PMI even without significant ST elevation in posterior leads. Hence there is a need for suitable
criteria for PMI based on electrocardiographic manifestations in anterior leads, so that early and
accurate diagnosis can be established to prevent devastating complications, that arise from
deprivation of emergent reperfusion therapy.
