Clinical and Angiographic characteristics of patients with combined Anterior and Inferior ST-Segment Elevation on the Initial Electrocardiogram during acute Myocardial infarction

INTRODUCTION: Myocardial infarction is the common disease nowadays and ST elevation myocardial infarction is important one among the ACS (Acute Coronary Syndrome). It is quite rare a situation when patient presents with simultaneous ST elevation in both anterior and inferior leads during acute myocardial infarction. In this thesis, we are going to see the various implications of this rare presentation in myocardial involvement as assessed by electrocardiogram and distribution of lesions in coronary arteries as assessed by coronary angiogram. The life- saving and crucial use of reperfusion therapy for acute myocardial infarction (AMI) makes it important to find out the location of the coronary arterial lesion responsible for the infarct prior to initiating treatment.2In anterior AMIs, location of the lesion in the anterior descending artery (AD) has been associated with the amount of myocardial necrosis and prognostic events. An acute obstruction of the coronary artery causes extensive necrosis that is most oftenco-existed by hemodynamic deterioration. Therefore, localization of the coronary arterial lesion is useful in evaluating myocardium at risk and in selecting the therapeutic strategy to be used.5Recently, many studies in the medical literature find out which features of electrocardiography mainly spot the culprit artery responsible for the AMI and the location of the coronary arterial lesion. 20 AIM 1. To Evaluate the Clinical and Angiographic Significance of combined anterior and inferior St-Segment Elevation in the presenting ECG in patients with AMI, 2. To determine whether the AMI size as measured by aldrich score and ST elevation in the Leads v1 tov5 may relate to the coronary Angiographic lesion. MATERIALS AND METHODS: Inclusion Criteria: 1. Age from 18-75 years, 2. Acute coronary syndrome patients admitting in our ICCU , 3. Patients presenting with AWMI & IWMI. Exclusion Criteria: 1. Patients with previous history of myocardial infarction, 2. Previous history of Left ventricular dysfunction, 3. Previous history of Percutaneous coronary intervention, 4. Previous history of coronary artery bypass graft, 5. Patients with peripheral arterial disease, 6. Patients with chronic kidney disease, 7. Previous history of valve diseases or arrhythmias such as atrial fibrillation. RESULTS: Here we are going to analyse the data collected from the 52 patients of our study. Following are the tables showing the analysed data in respect to the variables and their significance. CONCLUSION 1. In cases presenting with combined anterior and inferior ST segment elevation on ECG during Acute MI, males were more affected than females. 2. Majority of patients presented with Killip class I and Moderate LV Dysfunction. 3. Majority of patients had lower Aldrich score predicting lesser area of myocardium is affected. 4. Majority of patients had single vessel disease in coronary angiogram. 5. The coronary angiographic lesion causing combined anterior and inferior ST segment elevation was most commonly Distal LAD, followed by Proximal RCA. 6. ST elevation more inlead V1 than in lead V3 indicates Proximal RCA lesion in the presence of ST elevation in inferior leads. 7. ST elevation more in leadV3 than in lead V1 indicates Distal LAD lesion in the presence of ST elevation in inferior leads. 8. Patients with lower Aldrich scores have more Distal LAD lesions than those with the higher scores who had more Proximal LAD lesions than the distal ones. 9. In the presence of ST elevation in inferior leads, progressive increase in ST elevation from leads V1 to V5 indicates lesion in Distal LAD, and progressive decrease in ST segment elevation from leads V1 to V5 indicates lesion in Proximal RCA, both of which are important culprits in our study. 10. SCAI type of coronary lesions predominating in our study is type A lesion with 83%, followed by type B lesion with 13% and the least by type C lesion with 4%. 11. Further studies are needed in the future with large group of patients to further validate these findings