A prolonged QT interval upon arrival (≥445 ms) in patients with ST-elevation myocardial infarction was independently associated with an increased risk of all-cause mortality (HR 2.54).
Cohort (n=1,054)
No
Does a prolonged QT interval upon arrival predict mortality in patients with ST-elevation myocardial infarction?
Prolonged QT interval during STEMI is associated with increased short- and long-term all-cause mortality, with gender acting as an important mediator.
Effect estimate: HR 2.54 (95% CI 1.56-4.13)
p-value: p=0.01
Background An association between excessively prolonged QT and ventricular arrhythmia in patients with ST-elevation myocardial infarction has been described; however, the QT dynamics, characterization, and long-term predictive value are not well known. Objective To characterize QT interval dynamics in patients undergoing ST elevation myocardial infarction (STEMI) and determine its association with mortality. Methods A retrospective analysis of 4,936 consecutive patients, hospitalized for STEMI between 01/2013–12/2021. Patients with less than three electrocardiograms (ECGs) during index hospitalization were excluded. Baseline demographics, cardiovascular history, clinical risk factors, treatment measures, laboratory results, and mortality data were retrieved from the hospital’s electronic medical records. Results We included 1,054 patients and 5,021 ECGs in our cohort with a median follow-up of 6 years interquartile range (IQR) 4.3–7.4 years. The QT was longer in women in comparison to men (428.6 ms ± 33.4 versus 419.8 ms ± 32.52, P -value = 0.001). QT prolongation was greater in females, elderly patients, and patients with STEMI caused by occlusion of the left anterior descending (LAD) coronary artery. We determined QT cutoff to be 445 ms. This value of QT divided our cohort upon arrival into a long QT group (217 patients, 26% of the cohort) and a “normal” QT group (835 patients, 74% of the cohort). The long QT group experienced an increase in combined short and long terms all-cause mortality. The QT upon arrival, on day 2 of hospitalization, and before discharge from the hospital, correlated with long-term mortality. Conclusion QT duration is often prolonged during STEMI; this prolongation is associated with increased mortality and adverse events. Gender is an important mediator of QT dynamics.
Mann et al. (Fri,) conducted a cohort in ST-elevation myocardial infarction (n=1,054). Long QT interval (≥445 ms) vs. Normal QT interval (<445 ms) was evaluated on All-cause mortality (HR 2.54, 95% CI 1.56-4.13, p=0.01). A prolonged QT interval upon arrival (≥445 ms) in patients with ST-elevation myocardial infarction was independently associated with an increased risk of all-cause mortality (HR 2.54).
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