ORGINAL ARTICLE “Tombstoning” of ST segment in acute myocardial infarction – effect on clinical course

Abstract

Introduction: There are many reports evaluating the effects of the amplitude of ST segment elevation in acute myocardial infarction with ST segment elevation (STEMI) on infarction zone and course. There are, however, few publications dealing with the effects of ST segment elevation shape in STEMI patients on their clinical course and prognosis. Aim: Assessment of the rate of “tombstoning” of ST segment (TOMB-ST) in STEMI patients and the effects on their clinical outcome. Methods: The study involved 207 consecutive patients with STEMI hospitalised in the period 2000-2002 analysed with respect to the in-hospital complication rate. Results: On admission, TOMB-ST was observed in 55 (26.1%) subjects. TOMB-ST was more common in anterior MI (39.8%) than in inferior MI (10.6%). Patients with TOMB-ST compared to non-TOMB-ST ones had a significantly higher mortality rate (38.2% vs 9.9%, p <0.001), heart failure (45.6% vs 28.3%, p <0.026), ventricular fibrillation (18.1% vs 6.4%, p <0.016), and lower left ventricular ejection fraction (40.9% vs 48.6%, p <0.001). The sum of amplitudes of ST segment deviations (SST) >20 mm was indicative for the subgroup of patients with TOMB-ST and trend towards higher mortality (40% vs 30%, NS). However, in patients without TOMB-ST, SST >20 mm identified two subgroups with significantly different mortality rates (20% vs 4%, p=0.001). Conclusions: TOMB-ST was observed in one fourth of patients with STEMI. This abnormality was associated with an increased mortality rate, higher incidence of heart failure and ventricular fibrillation as well as decreased left ventricular ejection fraction. In the population with TOMB-ST, increased mortality was independent of the total amplitude of ST segment displacement; this relation was, however, observed in patients with STEMI without TOMB-ST.