Comparison of Regional Wall Motion Abnormalities in STEMI(+) vs. STEMI(-) Occlusion Myocardial Infarction

Abstract

Purpose: We aimed to determine if there are similar rates of regional wall motion abnormalities (RWMAs) in patients with acute coronary occlusion myocardial infarction (ACOMI, or OMI for short) with and without STEMI criteria on electrocardiogram (ECG).

Methods: We performed a retrospective review of a database of patients at high risk for acute coronary syndrome (ACS) with previously established outcomes for the presence of OMI in order to compare rates of RWMA in patients presenting with STEMI(+) OMI vs. STEMI(-) OMI. Furthermore, we compared how often the RWMA aligned with the anatomical territory observed on ECG.

Results: Among 808 patients, 551 underwent formal echocardiography, including 256 of 265 OMI patients and 295 of 543 patients with No Occlusion. Of the 256 OMIs that underwent formal echocardiography, only 41% (105/256) met STEMI criteria. 90% (94/105) of STEMI(+) OMI patients had RWMA compared to 82% (124/151) of STEMI(-) OMI patients (p = 0.10 [95 CI: -1.63% to 15.6%]). Both groups had greater prevalence of RWMA than the NOMI group (45%). RWMA matched the anatomic territory predicted by ECG in 92.5% of STEMI(+) OMI, 82.3% of STEMI(-) OMI, and 2.9% of the NOMI cohorts.

Conclusion: Location of RWMA was well-correlated with ECG findings regardless of the presence or absence of STEMI criteria. Prospective study is warranted to determine the utility of echocardiography in the detection of STEMI(-) OMI.

Keywords: ECG; Echocardiography; Electrocardiogram; OMI; Regional Wall Motion Abnormality; STEMI.