Predictive Value of Admission Electrocardiogram For Multivessel Disease in Acute Anterior and AnteriorJnferior Myocardial Infarction Turhan Kurum, M.D., Erkan Oztekin, M.D., Fatih Ozgelik, M.D., Huseyin Eker, M.D., Mevlut Ture*, Ph.D., and Giiltag Ozbay, M.D. From the Trakya University, School of Medicine, Department of Cardiology and Biostatistics", Edirne , Turkey Background: Our aim was to investigate the correlation between admission ECG and coronary angiography findings in terms of predicting the culprit vessel responsible for the infarct or multivessel disease in acute anterior or anterior-inferior myocardial infarction (AMI). Methods: We investigated 101 patients with a diagnosis of anterior AM1 with or without ST- segment elevation or ST-segment depression in at least two leads in DII, 111, aVF. The patients were classified as those with vessel involvement in the left anterior descending (LAD) coronary artery and patients with multivessel disease. Vessel involvement in LAD + circumflex artery (Cx) or LAD + right coronary artery (RCA) or LAD + Cx + RCA were considered as multivessel disease. Thus, (a) anterior AM1 patients with reciprocal changes in inferior leads, (b) anterior AM1 patients with inferior elevations, (c) all anterior AM1 patients according to the ST-segment changes in the inferior region were analyzed according to the presence of LAD or multivesssel involvement. Results: Presence of ST-segment depression in aVL and V6 was significantly correlated with the presence of multivessel disease in anterior AM1 patients with reciprocal changes in the inferior leads (P = 0.005 and P = 0.003, respectively). No statistically significant difference between the leads were detected in terms of ST-segment elevation in predicting vessel involvement in the two groups of anterior AM1 patients with inferior elevations. When all the patients with anterior AM1 were analyzed, the presence of ST-segment depression in leads aVL, V4, V5 and V6 were significantly associated with the presence of multivessel disease (P = 0.035, P = 0.01 0, P = 0.01 1, P = 0.001, respectively). Conclusions: The presence of ST-segment depression in anterolateral leads in the admission ECG of anterior AM1 patients with reciprocal changes in inferior leads was associated with multivessel acute anterior myocardial infarction; acute inferior myocardial infarction; electrocardiography; reciprocal changes; infarct-related artery disease. A.N.E. 2002;7(4):369-373 In admission ECG's of patients with anterior wall acute myocardial infarction (AMI) , ST-seg- ment elevations may be seen in the chest leads, and ST-segment depression or ST-segment elevation is sometimes observed simultaneously in the inferior leads. ST-segment depression in inferior leads as- sociated with anterior wall AM1 is usually sug- gested to be a reciprocal change of ST-segment elevation in the chest leads, whereas inferior ST- segment elevation occurring during anterior AM1 are linked to the size of anterior wall AMI.I.2There are few studies on vessel involvement which are responsible for reciprocal changes and those cases with co-existinginferior AMI. We assessed patients with anterior AM1 according to ST-segment changes in inferior leads and intended to correlate ~ ~ ~ ~ ~~ ~~ ~~ Address for reprints: Turhan Kiiyiim, M.D., Trakya Universitesi Tip Fakiiltesi, Kardiyoloji Anabilim Dah, 22030, Edirne, Turkey. Fax: +90 284 235 27 30: E-mail: turhankuruml@superonline.com 369