{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T19:00:03Z","timestamp":1766516403668,"version":"3.48.0"},"reference-count":21,"publisher":"BMJ","issue":"6486","license":[{"start":{"date-parts":[[1985,6,29]],"date-time":"1985-06-29T00:00:00Z","timestamp":488851200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1985,6,29]]},"abstract":"<jats:p>The clinical relevance of reciprocal changes in the ST segment occurring at the time of acute myocardial infarction was studied prospectively in 85 consecutive uncomplicated cases. Reciprocal depression of the ST segment was defined as depression of 1 mm or more in electrocardiogram leads other than those reflecting the infarct. All patients underwent maximal, symptom limited treadmill stress testing two weeks after the infarct and coronary angiography six weeks after infarction. Forty six patients had inferior, 34 anterior, and five true posterior infarction. Of the 51 patients with reciprocal changes, 45 (88%) developed exercise induced ST segment depression in areas remote from the infarction zone. At angiography all 45 patients were shown to have stenoses greater than 70% in at least two major vessels. Four patients had negative exercise electrocardiograms and were sequently shown to have single vessel disease subtending their infarct, and the remaining two patients had a false negative treadmill test result. Of the 27 patients without reciprocal changes, 21 (78%) had negative treadmill stress test results associated with single vessel coronary disease. Five had positive stress test results and multivessel coronary disease, and one had a false negative stress test result. The remaining seven patients had ST segment elevation without Q wave formation in the reciprocal areas and were assessed separately. Of these, six had positive stress test results and multivessel coronary disease and one had a negative stress test result and single vessel coronary disease to the infarct area. Twenty one patients with anterior infarcts (62%) and 27 with inferior infarcts (59%) had reciprocal changes. No differences emerged in the relation between infarct site, reciprocal change, and presence of additional coronary disease. At follow up of the 51 patients with reciprocal changes in the ST segment 36 had become symptomatic, of whom 29 had undergone coronary artery bypass surgery. By contrast, only four of the 27 patients without reciprocal changes in the ST segment had developed symptoms, and two of these had undergone coronary revascularisation. Reciprocal ST segment depression at the time of acute myocardial infarction may identify patients with severe coronary disease who are at risk of subsequent cardiac events and appears to be as reliable as results of early postinfarction treadmill stress testing in predicting the underlying coronary anatomy. When the electrocardiogram does not show reciprocal changes treadmill testing provides valuable additional information.<\/jats:p>","DOI":"10.1136\/bmj.290.6486.1931","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"1931-1934","source":"Crossref","is-referenced-by-count":16,"title":["Reciprocal change in ST segment in acute myocardial infarction: correlation with findings on exercise electrocardiography and coronary angiography."],"prefix":"10.1136","volume":"290","author":[{"given":"F","family":"Akhras","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Upward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1985,6,29]]},"reference":[{"key":"ref_1","first-page":"232","article-title":"Myocardial infarction","author":"Marriott, H.J.L.","year":"1977","unstructured":"Marriott HJL. Myocardial infarction. In: Marriott HKL, ed. Practical electrocardiography. Baltimore: Williams and Wilkins, 1977:232-55."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/0002-8703(49)90564-5","article-title":"Correlations of electrocardiographic and pathologic findings in anteroposterior infarction","volume":"37","author":"Myers, G.B.; Klein, H.A.; Hiratzka, T.","year":"1949","unstructured":"Myers GB, Klein HA, Hiratzka T. Correlations of electrocardiographic and pathologic findings in anteroposterior infarction. Am Heart J 1949;37:205-36.","journal-title":"Am Heart J"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/0002-9149(81)90313-1","article-title":"Anterior ST segment depression in acute inferior myocardial infarction: indication of posterolateral infarction","volume":"48","year":"1981","unstructured":"Goldberg HL, Borer JS, Jacobstein JG, Kluger J, Scheidt SS, Alonso DR. Anterior ST segment depression in acute inferior myocardial infarction: indication of posterolateral infarction. Am J Cardiol 1981;48:1009-15.","journal-title":"Am J Cardiol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/S0002-9149(80)80002-6","article-title":"Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction","volume":"45","author":"Shah, P.K.; Pichler, M.; Berman, D.S.; Singh, B.N.; Swan, H.J.C.","year":"1980","unstructured":"Shah PK, Pichler M, Berman DS, Singh BN, Swan HJC. Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction. 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Preponderance of acute proximal left anterior descending coronary artery lesions in fatal myocardial infarction: a clinicopathologic study. Am J Cardiol 1981;47:1189-96.","journal-title":"Am J Cardiol"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/0002-9149(80)90501-9","article-title":"Clinical and arteriographic variables predictive of survival in coronary artery disease","volume":"46","author":"Platia, E.V.; Grunwald, L.; Mellits, E.D.; Humphries, J.D.; Griffith, L.S.C.","year":"1980","unstructured":"Platia EV, Grunwald L, Mellits ED, Humphries JD, Griffith LSC. Clinical and arteriographic variables predictive of survival in coronary artery disease. Am 7 Cardiol 1980;46:543-52.","journal-title":"Am 7 Cardiol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S0002-9149(77)80207-5","article-title":"Chronic stable inferior myocardial infarction: unsuspected harbinger of high-risk proximal left coronary arterial obstruction amenable to surgical revascularization","volume":"39","author":"Miller, R.R.; DeMaria, A.N.; Vismara, L.A.","year":"1977","unstructured":"Miller RR, DeMaria AN, Vismara LA, et al. Chronic stable inferior myocardial infarction: unsuspected harbinger of high-risk proximal left coronary arterial obstruction amenable to surgical revascularization. Am J Cardiol 1977;39: 954-60.","journal-title":"Am J Cardiol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1161\/01.CIR.62.3.509","article-title":"Ischemia at a distance after acute myocardial infarction: a cause of early postinfarcetion angina","volume":"62","author":"Schuster, E.H.; Bulkley, B.H.","year":"1980","unstructured":"Schuster EH, Bulkley BH. Ischemia at a distance after acute myocardial infarction: a cause of early postinfarcetion angina. Circulation 1980;62:509-15.","journal-title":"Circulation"},{"key":"ref_10","article-title":"Ischemia at a distance: a malignant form of early postinfarct angina [Abstract]. Circulation 1980; 62(suppl III)","volume-title":"215.","author":"Schuster, E.H.; Bulkley, B.H.","unstructured":"Schuster EH, Bulkley BH. Ischemia at a distance: a malignant form of early postinfarct angina [Abstract]. Circulation 1980;62(suppl III):215."},{"author":"Bertrand, M.E.; Lablanche, J.M.; Tilmant, P.Y.; Thieuleux, F.A.; Deforge, M.G.; Chahine, R.A.","unstructured":"Bertrand ME, Lablanche JM, Tilmant PY, Thieuleux FA, Deforge MG, Chahine RA. The provocation of coronary arterial spasm in patients with recent transmural myocardial infarction. Eur Heart 7 (in press).","article-title":"The provocation of coronary arterial spasm in patients with recent transmural myocardial infarction","key":"ref_11"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1161\/01.CIR.60.2.451","article-title":"Multivessel coronary artery spasm","volume":"60","author":"Dunn, R.F.; Kelly, D.T.; Sadick, N.; Uren, R.","year":"1979","unstructured":"Dunn RF, Kelly DT, Sadick N, Uren R. Multivessel coronary artery spasm. Circulation 1979;60:451-5.","journal-title":"Circulation"},{"key":"ref_13","first-page":"634","article-title":"\"Reciprocal\" depression of the ST segment in acute myocardial infarction","volume":"287","author":"Jennings, K.; Reid, D.S.; Julian, D.G.","year":"1983","unstructured":"Jennings K, Reid DS, Julian DG. \"Reciprocal\" depression of the ST segment in acute myocardial infarction. Br MedJ3 1983;287:634-7."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1136\/bmj.284.6325.1293","article-title":"Early exercise testing and coronary angiography after uncomplicated myocardial infarction","volume":"284","author":"Akhras, F.; Upward, J.; Stott, R.; Jackson, G.","year":"1982","unstructured":"Akhras F, Upward J, Stott R, Jackson G. Early exercise testing and coronary angiography after uncomplicated myocardial infarction. Br Med J 1982;284: 1293-4.","journal-title":"Br Med J"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/hrt.52.4.413","article-title":"Early exercise testing and elective coronary artery surgery after uncomplicated myocardial infarction: effect on morbidity and mortality","volume":"52","author":"Akhras, F.; Upward, J.; Keates, J.; Jackson, G.","year":"1984","unstructured":"Akhras F, Upward J, Keates J, Jackson G. Early exercise testing and elective coronary artery surgery after uncomplicated myocardial infarction: effect on morbidity and mortality. Br Heart J 1984;52:413-7.","journal-title":"Br Heart J"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1161\/01.CIR.66.4.732","article-title":"Precordial ST segment depression during acute myocardial infarction: clinical, scintigraphic, and angiographic correlations","volume":"66","author":"Gibson, R.G.; Crampton, R.S.; Watson, D.D.","year":"1982","unstructured":"Gibson RG, Crampton RS, Watson DD, et al. Precordial ST segment depression during acute myocardial infarction: clinical, scintigraphic, and angiographic correlations. Circulation 1982;66:732-41.","journal-title":"Circulation"},{"key":"ref_17","first-page":"182","article-title":"Anterior ST segment depression in inferior myocardial infarction: angiographic, ventriculographic and scintigraphic findings","volume":"II):","author":"O'Neill, W.; Walton, J.; Colfer, H.T.","year":"1982","unstructured":"O'Neill W, Walton J, Colfer HT, et al. Anterior ST segment depression in inferior myocardial infarction: angiographic, ventriculographic and scintigraphic findings [Abstract]. Circulation 1982;66(suppl II): 182.","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/0002-9149(81)90312-X","article-title":"Significance of reciprocal ST segment in anterior precordial leads in acute inferior myocardial infarction: concomitant left anterior descending coronary artery disease ?","volume":"48","author":"Salcedo, JR, Baird; MG, Chambers; RJ, Beanlands; D.S.","year":"1981","unstructured":"Salcedo JR, Baird MG, Chambers RJ, Beanlands DS. Significance of reciprocal ST segment in anterior precordial leads in acute inferior myocardial infarction: concomitant left anterior descending coronary artery disease ? Am J Cardiol 1981;48:1003-8.","journal-title":"Am J Cardiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/0002-9149(82)90306-X","article-title":"Clinical implications of anterior ST segment depression in patients with acute inferior myocardial infarction","volume":"50","author":"Croft, C.H.; Woodward, W.; Nicod, P.","year":"1982","unstructured":"Croft CH, Woodward W, Nicod P, et al. Clinical implications of anterior ST segment depression in patients with acute inferior myocardial infarction. Am J Cardiol 1982;50:428-36.","journal-title":"Am J Cardiol"},{"author":"Accepted 4 April 1985)","unstructured":"(Accepted 4 April 1985)","key":"ref_20"},{"key":"ref_21","article-title":"117 consecutive patients admitted to the surgical units of the Kent and Canterbury and Margate hospitals with acute abdominal pain, and who required abdominal radiography, were entered into the study. Subsequently 15 patients were rejected, usually because they were too ill to undergo one of the three standard views. Patients with an obvious clinical diagnosisfor example, appendicitis-who would not normally be referred for radiography were also excluded","author":"and, Between March","year":"1984","unstructured":"Between March and June 1984, 117 consecutive patients admitted to the surgical units of the Kent and Canterbury and Margate hospitals with acute abdominal pain, and who required abdominal radiography, were entered into the study. Subsequently 15 patients were rejected, usually because they were too ill to undergo one of the three standard views. Patients with an obvious clinical diagnosisfor example, appendicitis-who would not normally be referred for radiography were also excluded."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.290.6486.1931","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.290.6486.1931","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T17:40:33Z","timestamp":1765474833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.290.6486.1931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,6,29]]},"references-count":21,"journal-issue":{"issue":"6486","published-online":{"date-parts":[[1985,6,29]]},"published-print":{"date-parts":[[1985,6,29]]}},"alternative-id":["10.1136\/bmj.290.6486.1931"],"URL":"https:\/\/doi.org\/10.1136\/bmj.290.6486.1931","relation":{},"ISSN":["0267-0623","1468-5833"],"issn-type":[{"type":"print","value":"0267-0623"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1985,6,29]]}}}