Correlation of reciprocal ST-segment depression after acute myocardial infarction with coronary angiographic findings.

We studied 266 consecutive patients with acute myocardial infarction to assess the significance of electrocardiographic "mirror images". Ninety-four (group A) had anterior wall and 132 (group B) had inferior wall infarction. Thirty-one group A patients had stenosis of the right coronary artery greater than 85% in diameter (subgroup A1), and 63 either had a normal right coronary artery or less than 85% stenosis (subgroup A2). Of group B patients 62 had greater than 85% stenosis of the left anterior descending (subgroup B1) and 70 had a left anterior descending or less than 85% stenosis (subgroup B2). ST-segment depression was significantly greater in depth and duration in subgroup A1 than A2 (p = 0.02) and in subgroup B1 than B2 (p = 0.02, p = 0.01, respectively). Left ventricular ejection fraction was lower in subgroup A1 than A2 (p less than 0.001) and in B1 than B2 (p less than 0.001). There was a strongly positive correlation between depth and duration of ST-segment depression and the Gensini index (r = 0.78, 0.84) for anterior and inferior infarction, respectively. In conclusion, increased depth and duration of ST-segment depression opposite the infarct are indicative of ischemia, and are related to the extent of coronary artery disease, the degree of stenosis of the vessels supplying the opposite wall and of left ventricular dysfunction.

Plasma atrial natriuretic factor in uncomplicated acute myocardial infarction.

Plasma atrial natriuretic factor (ANF) levels were measured in 29 patients who had normal atrial hemodynamics on days 4 and 8 after an uncomplicated acute myocardial infarction (AMI). All patients had increased ANF levels on day 4. On day 8 of the ANF levels had declined significantly to normal values in 14 patients with enzymatically smaller AMI and higher ejection fractions (> or = 40%), while they remained elevated in 16 patients with larger AMI and lower ejection fractions (< 40%). The study data are compatible with increased secretion of ANF by the more extensively damaged left ventricles in AMI.

Early ventricular fibrillation in patients with acute myocardial infarction: correlation with coronary angiographic findings.

To define coronary angiographic characteristics of patients experiencing early primary ventricular fibrillation (VF) in the acute phase of myocardial infarction we studied 266 consecutive patients without clinical evidence of heart failure. Twenty-six patients (group 1) experienced early (< 12 h from the onset of symptoms of myocardial infarction) primary VF whereas 240 patients (group 2) with the same clinical characteristics served as an appropriately matched cohort. All patients were catheterized before or soon after hospital discharge (1 to 8 weeks after the acute event). There was no significant difference in left ventricular ejection fraction between the two groups of patients (39.6 +/- 6% vs 36.9 +/- 8%, P = ns). Patients with early VF had a significantly greater number of diseased vessels than those without VF (3.38 +/- 1.05 vs 2.03 +/- 1.25, P < 0.001) and a higher coronary arteriographic Gensini score (29.31 +/- 4.80 vs 20.16 +/- 4.14, P < 0.001). The left anterior descending coronary artery was identified as the infarct-related vessel in 53.6% of group 1 vs 44.5% of group 2 patients (P < 0.05). The mean maximal serum creatine kinase values were not significantly different (1897 +/- 1062 vs 1426 +/- 839 IU.l-1, P = ns) between the two groups. These data indicate that patients with early primary VF in the setting of acute myocardial infarction may have more extensive coronary artery disease than similar patients without VF. A worse prognosis could be anticipated for these patients on the basis of worse coronary anatomy.(ABSTRACT TRUNCATED AT 250 WORDS)