Prevalence and prognosis of isolated posterior ST-segment elevation acute myocardial infarction using synthesized-V7-9 lead.

Abstract

Limited data exist on the prevalence and prognosis of isolated posterior ST-segment elevation acute myocardial infarction (STEMI), revealed with a posterior chest lead. Furthermore, the utility of a synthesized-V7-9 lead in the diagnosis of STEMI is unclear; therefore, we aimed to evaluate its usefulness. We enrolled 142 consecutive patients with STEMI with the culprit lesion on the left circumflex artery (STEMI-LCx) undergoing percutaneous coronary intervention (PCI) between January 2009 and December 2019. We retrospectively checked the ST-segment change of both standard 12-lead and synthesized-V7-9 lead in all patients with STEMI-LCx. Based on electrocardiogram (ECG) findings, isolated posterior STEMI that was only revealed in synthesized-V7-9 lead was classified as "STEMI-LCx-synV7-9" and the remaining as "STEMI-LCx-12ECG." The prevalence of STEMI-LCx-synV7-9 in patients with STEMI-LCx was assessed. The incidence of all-cause death, cardiac death, and mechanical complications within 30 days, 3 months, and 1 year was also assessed according to each STEMI-LCx. STEMI-LCx-synV7-9 and STEMI-LCx-12ECG occurred in 10 (7.0%) and 132 (93.0%) patients, respectively. No significant difference was found in patients' characteristics between the two groups. The patients with STEMI-LCx-synV7-9 had significantly higher incidences of cardiac death within 3 months and 1 year (30.0% vs. 6.1%, P = 0.031, 30.0% vs. 7.6%, P = 0.050, respectively) and mechanical complications in each follow-up period (20.0% vs. 1.5%, P = 0.025) than those with STEMI-LCx-12ECG. STEMI-LCx-synV7-9 was observed in 7.0% of the patients with STEMI-LCx. Our findings suggest that the synthesized-V7-9 lead helps diagnose isolated posterior STEMI and might improve prognosis in patients with STEMI-LCx.

• Authors: Kazuki Shimojo, Kensuke Takagi, Yasuhiro Morita, Yasunori Kanzaki, Hiroaki Nagai, Naoki Watanabe, Naoki Yoshioka, Ryota Yamauchi, Shotaro Komeyama, Hiroki Sugiyama, Takuro Imaoka, Gaku Sakamoto, Takuma Ohi, Hiroki Goto, Hideyuki Tsuboi, Itsuro Morishima
• Journal: Cardiovascular intervention and therapeutics (Cardiovasc Interv Ther) Vol. 37 Issue 2 Pg. 343-353 (Apr 2022) ISSN: 1868-4297 [Electronic] Japan
• PMID: 34542792 (Publication Type: Journal Article)
• Copyright: © 2021. Japanese Association of Cardiovascular Intervention and Therapeutics.

Topics

• Electrocardiography
• Humans
• Myocardial Infarction (epidemiology)
• Percutaneous Coronary Intervention
• Prevalence
• Prognosis
• Retrospective Studies
• ST Elevation Myocardial Infarction (diagnosis, surgery)