Relation between Initial QRS Duration with Myocardial Reperfusion after Primary PCI
AbstractBackground.Reperfusion therapy in acute myocardial infarction aims at early and sustained reperfusion of the myocardium at risk. However, even when TIMI flow 3 is achieved, some patients have less optimal reperfusion at myocardial tissue level. QRS duration before reperfusion therapy was showed as a predictor of myocardial reperfusion after fibrinolytic therapy, but currently there is no data showing relationship between QRS dura-tion at admission with myocardial reperfusion after primary percutaneous coronary intervention (primary PCI).
Methods.A case control study was conducted to study the relationship between QRS duration at admission with myocardial reperfusion after pri-mary PCI. Myocardial reperfusion was assessed by myocardial blush grade (MBG), and was grouped as optimal reperfusion (MBG 2-3) and impaired reperfusion (MBG 0-1).
Results.There were 41 patients fulfilling study criteria. Thirty one patients had optimal reperfusion and 10 patients had impaired reperfusion. Impaired reperfusion group had longer QRS duration (103 +14 vs 91 +12 ms; p = 0,013) and were older (63,9 +12,2 vs 53,7 +10,3 years, p = 0,023). The two groups were similar in terms of gender, diabetes, hypertension, dyslipidemia, smoking status, pain-to-door time, pain-to-balloon time, infarct-related artery location, and TIMI flow. Multivariate analysis showed that longer QRS duration was associated with impaired reperfusion after primary PCI (OR: 21.7, p = 0.014). QRS duration of more than 105 ms was a predictor of impaired reperfusion after primary PCI, with 84% sensitivity and 62% specificity.
Conclusions.Longer QRS duration at admission is a predictor of impaired myocardial reperfusion after primary PCI. Patients with STEMI who have QRS duration of more than 105 ms should be considered to be at higher risk of impaired reperfusion after primary PCI.
Henriques JP, Zijlstra F, van ‘t Hof AW, de Boer MJ, Dambrink JH, Gosselink M, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003;107(16):2115-2119.
Gibson CM, Schomig A. Coronary and myocardial angio-graphy: angiographic assessment of both epicardial and myocardial perfusion. Circulation. 2004;109(25):3096-3105.
van ‘t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reper fusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97(23):2302-2306.
Kacmaz F, Maden O, Aksuyek S, Ureyen C, Alyan O, Erbay AR, et al. Relationship of admission QRS duration and changes in QRS duration with myocardial reperfusion in patients with acute ST segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy. Circ J. 2008;72(6):873-879.
Wong CK, Gao W, Stewart RA, van Pelt N, French JK, Aylward PE, et al. Risk stratification of patients with acute anterior myocardial infarction and right bundle-branch block: importance of QRS duration and early ST-segment resolution after fibrinolytic therapy. Circulation. 2006;114(8):783-789.
Maden O, Kacmaz F, Selcuk MT, Selcuk H, Alyan O, Aksu T, et al. Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions. J Electrocardiol. 2008;41(1):72-77.
Suzuki M, Saito M, Nagai T, Saeki H, Tatsuno H, Kazatani Y. Association between initial QRS duration and no-reflow phenomenon in patients with acute left main coronary artery obstruction. Am J Cardiol. 2003;91(12):1469-1471, A1466-1468.
The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med. 1985;312(14):932-936.
Weston P, Johanson P, Schwartz LM, Maynard C, Jennings RB, Wagner GS. The value of both ST-segment and QRS complex changes during acute coronary occlusion for prediction of reperfusion-induced myocardial salvage in a canine model. J Electrocardiol. 2007;40(1):18-25.
Cantor AA, Goldfarb B, Ilia R. QRS prolongation: a sensitive marker of ischemia during percutaneous transluminal coronary angioplasty. Catheter Cardiovasc Interv. 2000;50(2):177-183.
Cantor A, Goldfarb B, Aszodi A, Battler A. QRS prolongation measured by a new computerized method: a sensitive marker for detecting exercise-induced ischemia. Cardiology. 1997;88(5):446-452.
Tsukahara K, Kimura K, Kosuge M, Shimizu T, Sugano T, Hibi K, et al. Clinical implications of intermediate QRS prolongation in the absence of bundle-branch block in patients with ST-segment-elevation acute myocardial infarction. Circ J. 2005;69(1):29-34.
Michaelides A, Dilaveris P, Psomadaki Z, Theoharis A, Andrikopoulos G, Richter D, et al. Exercise-induced prolongation of the infarct-related Q-waves as a marker of myocardial viability in the infarcted area. Int J Cardiol. 2004;94(2-3):261-267.
Horvath G, Racker DK, Goldberger JJ, Johnson D, Jain S, Kadish AH. Electrophysiological and anatomic heterogeneity in evolving canine myocardial infarction. Pacing Clin Electrophysiol. 2000;23(7):1068-1079.
de Bakker JM, van Capelle FJ, Janse MJ, Tasseron S, Vermeulen JT, de Jonge N, et al. Slow conduction in the infarcted human heart. ‘Zigzag’ course of activation. Circulation. 1993;88(3):915-926.
Korosoglou G, Haars A, Michael G, Erbacher M, Hardt S, Giannitsis E, et al. Quantitative evaluation of myocardial blush to assess tissue level reperfusion in patients with acute ST-elevation myocardial infarction: incremental prognostic value compared with visual assessment. Am Heart J. 2007;153(4):612-620.
Mirvis DM, Goldberger AL. Electrocardiography. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia: Elsevier Saunders; 2005:107-152.
Attar MN, Wong K, Groves DG, Newall N, Ramsdale DR, Moore RK. Clinical implications of QRS duration and QT peak prolongation in patients with suspected coronary disease referred for elective cardiac catheterization. Ann Noninvasive Electrocardiol. 2008;13(2):106-112.
Brilakis ES, Mavrogiorgos NC, Kopecky SL, Rihal CC, Gersh BJ, Williams BA, et al. Usefulness of QRS duration in the absence of bundle branch block as an early predictor of survival in non-ST elevation acute myocardial infarction. Am J Cardiol. 2002;89(9):1013-1018.
Chou T-C. Normal electrocardiogram. Electrocardiography in clinical practice. Philadelphia: W.B. Saunders Company; 1991:3-22.
PDF (Bahasa Indonesia) downloads: 1073
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).