Prediction of reciprocal ST segment changes in determining the extent of coronary artery disease in ST segment elevation myocardial infarction: An angiographic correlation

Background: In patient with history suggestive of myocardial infarction, ST segment elevation in ECG is supportive of MI. Mechanism of reciprocal changes is still a debate. The reason for ST segment depression has been extensively investigated, with conflicting results. Possible hypothesis for the mechanism of reciprocal changes are concomitant stenosis of other vessels or merely a benign electrical activity. Objectives: To identify reciprocal ST Segment depression in ST segment elevation acute myocardial infarction and predict the extent of coronary artery disease by correlating with coronary angiography, to assess left ventricular dysfunction in patient with and without reciprocal ST Segment changes. Materials and methods: The study was conducted over 18 months among 80 patients who were admitted to FMMCH with STEMI. They were analyzed in two groups with 40 patients with anterior wall MI and 40 patients with Inferior wall MI with reciprocal changes and those without reciprocal changes. Results: Among the 80 patients, 57% belonged to age 45-65 years, with male was to female ratio was 4:1. Reciprocal changes seen in multi vessel disease were statistically significant (p value 0.000). Cases with reciprocal changes 42.5% had severe LV dysfunction (p value 0.03) which was statistically significant. Reciprocal changes seen in multi vessel disease were statistically significant (p value 0.0). Conclusion: This study showed statistical significant positive correlation between reciprocal ST segment changes, multi vessel coronary artery disease and severity of left ventricular dysfunction. Emphasizing the need for urgent evaluation and treatment patients with reciprocal ST segment changes among the patient with ST elevation myocardial infarction.