Key result
An increased frontal QRS-T angle was a significant predictor of TIMI flow grade 0/1 before revascularization (OR 1.51) and in-hospital adverse events in patients with non-ST-elevation myocardial infarction.
Why the study?
The frontal QRS-T angle may be affected by coronary blood flow changes, but its relationship with coronary flow grade and adverse events in non-ST-elevation myocardial infarction was unclear.
Does a wider frontal QRS-T angle predict poor coronary flow (TIMI 0/1) and in-hospital adverse events in patients with NSTEMI?
Observational (n=191)
No
Does a wider frontal QRS-T angle predict poor coronary flow (TIMI 0/1) and in-hospital adverse events in patients with NSTEMI?
Odds Ratio: 1.51 (95% CI 1.3–1.75)
p-value: p=<0.001
A widened frontal QRS-T angle (≥73.5°) on admission ECG in NSTEMI patients is a useful non-invasive predictor of poor pre-PCI coronary flow (TIMI 0/1) and in-hospital adverse events.
Wider frontal QRS-T angle associated with poor flow and events in NSTEMI; hypothesis-generating for ECG risk stratification pending validation.
OBJECTIVE: Electrocardiography is used in the initial risk assessment of patients with non-ST-elevation myocardial infarction. The frontal QRS-T angle is an electrocardiography parameter that may be affected by the alterations in the coronary blood flow. This study aimed to explore the relationship of the frontal QRS-T angle with coronary flow grade and adverse events in non-ST-elevation myocardial infarction patients. METHODS: A total of 191 non-ST-elevation myocardial infarction patients were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow level on coronary angiography before revascularization, namely TIMI 0/1 and TIMI 2/3. The frontal QRS-T angle obtained before revascularization was compared between the groups and its relationship with adverse events was examined. In-hospital all-cause mortality, repeat target lesion revascular-ization, new-onset heart failure, ventricular arrhythmias, and atrial fibrillation were defined as adverse events. RESULTS: Frontal QRS-T angle was wider in the patients with TIMI 0/1 flow compared to the patients with TIMI 2/3 flow (P < 0.001). The frontal QRS-T angle was determined to be a predictor of TIMI flow grade 0/1 before revascularization in patients with non-ST-elevation myocardial infarction (odds ratio: 1.51; 95% CI: 1.30-1.75; P < 0.001). The frontal QRS-T angle was a predictor of the adverse events during hospitalization in the patients with non-ST-elevation myocardial infarction (odds ratio: 1.11; 95% CI: 1.04-1.19; P = 0.002). The cut-off values of the frontal QRS-T angle for TIMI flow grade and adverse events were determined to be 73.5°, based on receiver operating characteristic curve analysis. CONCLUSION: Increased frontal QRS-T angle may be a useful electrocardiography parameter for determining TIMI flow grade and the need for an early invasive strategy in patients with non-ST-elevation myocardial infarction.
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Uğur Küçük (2023) conducted an observational in Non-ST-elevation myocardial infarction (NSTEMI) (n=191). Frontal QRS-T angle was evaluated on TIMI flow grade 0/1 before revascularization (OR 1.51, 95% CI 1.30-1.75, p=<0.001). An increased frontal QRS-T angle was a significant predictor of TIMI flow grade 0/1 before revascularization (OR 1.51) and in-hospital adverse events in patients with non-ST-elevation myocardial infarction.
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