Comparison of segmental wall motion abnormalities on echocardiography in patients with anteroseptal versus extensive anterior wall ST-segment elevation myocardial infarction

Abstract

ObjectiveAcute anteroseptal ST-segment elevation (STE) myocardial infarction (AS-STEMI), defined as STE limited to leads V1 to V3, has historically been associated with a smaller infarct size than extensive anterior STEMI (EA-STEMI), in which STE extends to leads V4 to V6. We compared the differences in global and regional wall motion by transthoracic echocardiography between patients with AS-STEMI and EA-STEMI. MethodsPatients who presented with anterior STEMI and underwent primary percutaneous coronary intervention between January 2008 and March 2011 were included. For each subject, a transthoracic echocardiogram that was performed within 24hours of admission was interpreted by an independent investigator blinded to the patient's electrocardiographic data. ResultsOf the 65 subjects who met our inclusion criteria, 30 had AS-STEMI and 35 had EA-STEMI. No differences were observed between groups in baseline characteristics or the mean number of hypokinetic, akinetic, and dyskinetic segments. Apical inferior segment dysfunction occurred more often in patients with EA-STEMI than in patients with AS-ASTEMI (71.4% vs 43.3%; P=.04). Distribution and extent of wall motion abnormalities were similar between patients with AS-STEMI and those with EA-STEMI. ConclusionThe term AS-STEMI may be misleading, as it implies that only the anteroseptal segments are involved. We show that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region.