Key result
Complete and simplified Selvester QRS scores showed comparable but inferior predictive validity for acute and chronic infarct size compared to peak hs-cTnT in patients with reperfused STEMI.
Why the study?
Complete and simplified Selvester QRS scores have been proposed for estimating myocardial damage in STEMI, but a comprehensive comparison of both scoring systems for predicting CMR-assessed myocardial and microvascular injury was needed.
Does the complete Selvester QRS score improve prediction of infarct severity compared to the simplified score or peak hs-cTnT in revascularized STEMI patients?
Observational (n=201)
Single-blind
No
Does the complete Selvester QRS score improve prediction of infarct severity compared to the simplified score or peak hs-cTnT in revascularized STEMI patients?
Effect estimate: AUC 0.64 (95% CI 0.56-0.72)
Absolute Event Rate: 0.64% vs 0.88%
p-value: p=0.001
Both complete and simplified Selvester QRS scores are inferior to peak hs-cTnT for predicting infarct size and microvascular obstruction in reperfused STEMI patients.
Selvester QRS scores should not supplant hs-cTnT for infarct sizing in STEMI; leaves open their incremental value in larger cohorts.
BACKGROUND: Complete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI. METHODS: In this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1-4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO). RESULTS: Complete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81. CONCLUSIONS: In reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.
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Tiller et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=201). Complete and simplified Selvester QRS score vs. Peak high-sensitivity cardiac troponin T (hs-cTnT) was evaluated on Prediction of acute infarct size (>15% of left ventricular myocardial mass) (AUC 0.64, 95% CI 0.56-0.72, p=0.001). Complete and simplified Selvester QRS scores showed comparable but inferior predictive validity for acute and chronic infarct size compared to peak hs-cTnT in patients with reperfused STEMI.
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