Tombstone ECG Pattern in Acute Anterior Wall Myocardial Infarction: Correlation with Risk Factors, In-Hospital Complications, and Prognostic Implications

Background and Objectives: The ‘tombstoning’ electrocardiographic (ECG) pattern is a particular kind of convex ST-segment change, as observed in some patients during the early stages of acute myocardial infarction (AMI). It has been suggested that this specific pattern of ECG changes following AMI predicts a poorer outcome in these patients. The objective is to study the correlation ‘tombstoning’ electrocardiographic pattern in patients with first anterior wall acute myocardial infarction with risk factors and in hospital complications Methods: This study investigated 73 patients with AMI whose ECGs were taken within 12 hours of onset of symptoms. The study population was divided into two groups based on the admission ECGs, ‘tombstoning’ vs. ‘non tombstoning’, and their clinical characteristics were compared. Results: In this study population of 73 patients, 27 (36.9%) had a definite ‘tombstoning’ pattern on their admission ECG. Compared with the ‘non tombstoning’ group, the significant differences in the ‘tombstoning’ group are as follows: infarction size is larger as evidenced by higher CK-MB levels (179.67 vs.90.57 IU); left ventricular ejection fraction is lower (40.56% vs. 47.86 %); periinfarct angina is lower (5 vs. 18.5 %), and in-hospital complications are higher. Conclusion: This study shows that ‘tombstoning’ electrocardiographic patterns was associated with lower ejection fraction, left ventricular dysfunction and more in hospital complications. Pattern of the ST elevation has been shown to be a strong prediction factor for LV function in acute anterior MI.