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- Title
Significance of ST segment elevation on the exercise electrocardiogram in patients without prior history of myocardial infarction.
- Authors
Murphy, J. C.; Scott, P. J.; McKavanagh, P.; Shannon, H. J.; Glover, B.; Dougan, J.; Walsh, S. J.; Adgey, A. A. J.
- Abstract
Background: Exercise induced ST segment elevation (STE) in patients without a history of myocardial infarction may be due to coronary artery spasm or stenosis. Methods: Between January 1998 and Dec 2005 14,941 exercise stress tests were performed in our department for assessment of chest pain in patients without prior history of myocardial infarction or Q-waves on the resting electrocardiogram (ECG). Patients who developed STE during exercise or in the recovery phase were identified and a review of case histories was carried out. Results: The incidence of STE was 0.78% (116/14941). The majority were male (92) with no age difference between the genders (male 56.4 +/-10.8 vs female 59.1 years +/-11.9 p=0.287). Coronary angiography was performed in 108 patients and 6 had myocardial scintigraphy. All patients undergoing angiography had at least one severe coronary artery stenosis (>70%). The site of ST elevation was subsequently confirmed by angiography to be 93.5% predictive of a tight stenosis in the corresponding coronary artery. A left anterior descending (LAD) artery stenosis was seen in 40/41 (97.6%) patients who developed anterior STE. A right coronary artery or dominant left circumflex artery (LCx) stenosis was seen in 61/66 (92.4%) of patients who had inferior STE. Lateral STE was rare (1/116). Of the 6 who had scintigraphy 3 had reversible reperfusion defects which correlated with the site of STE and 2 had inferior STE with fixed inferior defects. One patient had a normal perfusion study. Multivariate regression analysis was performed on those who underwent angiography. The only independent predictor of multi-vessel disease was increased time to resolution of STE with OR 1.097 (95% CI 1.014-1.187 p=0.021). Conclusion: STE on the exercise treadmill is rare but specific for ischaemic heart disease. The territory of STE is predictive of a severe stenosis in the corresponding artery.
- Subjects
EXERCISE; MYOCARDIAL infarction; CORONARY vasospasm; HEART blood-vessels; HEART diseases; ISCHEMIA
- Publication
Ulster Medical Journal, 2008, Vol 77, Issue 2, p139
- ISSN
0041-6193
- Publication type
Article