Evaluation of the extent of coronary arteriosclerosis by actute phase electrocardiogram in non-Q wave myocardial infarcts.

Abstract

To investigate the extent of coronary artery atherosclerotic changes and of the jeopardized myocardium, we performed coronary arteriography, left ventriculography and exercisE thallium-201 single photon emission computed tomography (SPECT) on 52 patients wit h non-Q wave myocardial infarction. Patients were divided into 3 groups according to the acute phase standard twelve-lead electrocardiographic findings: 11 patients with both the findings of the ST segment elevation in lead aVR and ST depression in any other leads except lead aVR (group 1); 16 patients with one of those (group 2); 25 patients without those (group 3). Mean value of the left ventricular ejection fraction in all subjects was 66%, and no significant differ. ences were observed among 3 groups. No significant major coronary artery stenosis (< 75% in diameter) were observed in 5 (31%) in group 2 and in 7 (28%) in group 3, however, none was observed in group 1. The incidence of multivessel disease, left anterior descending artery le sion and collateral vessels were significantly higher in group 1 compared to group 2 and 3 (p <.05) Gensini score and jeopardy score were also significantly higher in group 1 compared to group 2 and 3 (p <.01). Infarct region determined quantitatively by the unfolded map method using exersise thallium-201 SPECT was < 10% in each 3 group, and no significant differ ences were observed among 3 groups. On the other hand, ischemic region and transient ische mic region were significantly larger in group 1 compared to group 3 (p<.05, p<.01, respec tively) and had a tendency to being larger in group 1 compared to group 2. Thus, all the pa tients in group 1 had significant > 75% stenotic coronary artery lesion, and group 1 showed more extensive coronary artery sclerotic lesions and jeopardized myocardium than those in group 2 and 3.
Conclusion: Acute phase electrocardiographic findings of the ST elevation in lead aVR and ST depression in any other leads except lead aVR indicate advanced coronary artery atheroscler osis in nonQ wave myocardial infarcts.