ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction

Abstract

Background: Elevation of ST segment in leads V3R/V4R, which is commonly encountered in right ventricu-lar myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. Aims: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. Study Design: Prospective cohort study.Methods: Right precordial leads V3R/V4R were re-corded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST eleva-tion in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic in-formation, were recorded. In-hospital and 3 month mor-tality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also com-pared. Results: ST elevation in lead V3R or V4R was pres-ent in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of pa-tients with elevation vs. 53.8% of patients without el-evation, p=0.22). Post-myocardial infarction complica-tions, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection frac-tion (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39].Conclusion: Although ST elevation in V3R/V4R can be present in patients with left anterior descending ar-tery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this is-sue needs further investigation