• Remote ECG down-sloping
• acute myocardial infarcti

Background: Reciprocal ST-segment abnormalities are frequent in patients with ST-elevated myocardial infarction (STEMI). While an interaction between reciprocal ECG changes and the presence of remote myocardial ischemia has been suggested, the actual etiology of this phenomenon is still disputed.
Aims: To evaluate the relationships between reciprocal ST-segment abnormalities, coronary perfusion, and cardiac functional parameters in patients with STEMI.
Materials and methods: One-hundred and eighty-five consecutive patients with STEMI submitted to urgent coronary angiography were selected. The presence of reciprocal ST-segment down-sloping was evaluated on admission ECG. At coronary angiography, the corrected TIMI frame count (cTFC) at the level of each coronary vessels were computed and the occurrence of “no reflow” phenomenon after PCI identified. In every patient, the left ventricular wall-motion score index (WMSI) ratio (discharge/admission values) at echocardiography was computed, and the slope of high-sensitivity troponin (Hs-Tn) elimination was derived as measures of effective myocardial reperfusion.
Results: Reciprocal ST-segment abnormalities were revealed in 91 (49%) patients. Those patients presented higher cTFC values on non-culprit vessels than those without remote ECG abnormalities (P=0.004). Moreover, the presence of remote ECG changes also associated with a higher prevalence of “no reflow” phenomenon (P<0.001) as well as more abnormal WMSI ratio (P=0.042) and Hs-Tn slope (P=0.012), as signs of relatively ineffective myocardial reperfusion. Accordingly, in the whole population a correlation between cTFC values on non-culprit and culprit (post-PCI) vessels was evident (P=0.004). On multivariate analyses, a higher cTFC independently predicted the occurrence of reciprocal ST-segment changes (P=0.024) and remained a major determinant of the development of “no reflow” phenomenon (P=0.005).
Conclusions: In STEMI patients, reciprocal ST-segment abnormalities cluster with significant coronary perfusion and cardiac functional abnormalities. Specifically, those patients present a global impairment of coronary blood flow that predicts the development of “no reflow” phenomenon after PCI.