Michael E Farkouh1; Eugenia Nikolsky2; James Reiffel3; Ovidiu Dressler4; David A Baran5; Roxana Mehran6; Alexandra J Lansky6; Gregg W Stone6
    1 Mount Sinai Sch of Medicine， New York， NY
    2 Cardiovascular Rsch Foundation， New York， NY
    3 Columbia Univ Med Cntr/Cardiovascular Rsch Foundation， New York， NY
    4 Cardiovascular Rsch Foundation， New York， NY
    5 Newark Beth Israel Med Cntr， Newark， NJ
    6 Columbia Univ Med Cntr/Cardiovascular Rsch Foundation， New York， NY 
    Objective - To investigate correlations between reciprocal ST-segment depression on the baseline ECG， angiographic findings and clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). 
    Methods - Among 3602 pts enrolled in the prospective， randomized Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial， 2401 pts had the baseline ECG analyzed by an independent ECG core lab as part of a formal substudy. Reciprocal ST-segment depression defined as >0.1 mV depression in  1 adjacent leads in a territory remote from the site of ST-segment elevation was present in 1559 (64.9%) pts. Patients with posterior infarction were excluded. Angiographic analysis was performed by independent angiographic core lab.
    Results - Reciprocal ST-segment depression on baseline ECG correlated with higher incidence of non-LAD infarct vessel (72.2% vs. 37.9%)， baseline TIMI flow grade 0/1 (67.6% vs. 57.3%)， higher incidence of thrombus on baseline angiogram (84.3% vs. 75.2%)， larger reference vessel diameter (median: 2.9 vs. 2.8 mm) and shorter time from symptoms onset to 1st balloon inflation (median: 215.0 vs. 234.0 min) [all p<0.0001] but not with incidence of multivessel disease (58.4% vs. 54.7%， p=0.08) or lower baseline LVEF (median: 60.2% vs. 59.6%， p=0.55). Clinical outcomes are presented in the Table. By multivariable analysis， baseline reciprocal ST-segment depression was not predictive of mortality at 30 days (hazard ratio [95%CI] = 1.00 [0.38， 2.66]， p=0.99) or at 1 year (hazard ratio [95%CI] = 1.00 [0.47， 2.16]， p=0.99).
    Conclusion - Reciprocal ST-segment depression on the presenting ECG does not predict an adverse prognosis in patients with STEMI treated by primary PCI and is not correlated with multivessel disease or more extensive myocardial damage as assessed by LVEF.