Key result
Patients with acute STEMI had greater QT interval dispersion compared to those with acute pericarditis (69.8 vs 50.6 ms, P<0.001), and showed QRS prolongation in ST-elevation leads.
Why the study?
Does the addition of QRS and QT duration changes to classical ECG criteria improve the differentiation between acute pericarditis and acute STEMI?
Observational (n=150)
Does the addition of QRS and QT duration changes to classical ECG criteria improve the differentiation between acute pericarditis and acute STEMI?
Absolute Event Rate: 69.8% vs 50.6%
p-value: p=<0.001
Prolongation of the QRS complex and shortening of the QT interval in leads with ST-segment elevation are specific to acute STEMI and can help differentiate it from acute pericarditis.
May aid ECG differentiation of STEMI from pericarditis; leaves open prospective validation of added diagnostic value.
OBJECTIVE: Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute pericarditis and acute transmural myocardial ischemia. METHODS: Clinical records and 12-lead electrocardiogram (ECG) at ×2 magnification were analyzed in 79 patients with acute pericarditis and in 71 with acute ST-segment elevation myocardial infarction (STEMI). RESULTS: ECG leads with maximal ST-segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85.9 ± 13.6 ms vs 81.3 ± 10.4 ms, P = .01; QT: 364.4 ± 38.6 vs 370.9 ± 37.0 ms, P = .04), but not in patients with pericarditis (QRS: 81.5 ± 12.5 ms vs 81.0 ± 7.9 ms, P = .69; QT: 347.9 ± 32.4 vs 347.3 ± 35.1 ms, P = .83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69.8 ± 20.8 ms vs 50.6 ± 20.2 ms, P <.001). The diagnostic yield of classical ECG criteria (PR deviation and J point level in lead aVR and the number of leads with ST-segment elevation, ST-segment depression, and PR-segment depression) increased significantly (P = .012) when the QRS and QT changes were added to the diagnostic algorithm. CONCLUSIONS: Patients with acute STEMI, but not those with acute pericarditis, show prolongation of QRS complex and shortening of QT interval in ECG leads with ST-segment elevation. These new findings may improve the differential diagnostic yield of the classical ECG criteria.
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Rosselló et al. (2013) conducted an observational in Acute pericarditis and acute STEMI (n=150). Acute STEMI vs. Acute pericarditis was evaluated on QT interval dispersion among the 12-ECG leads (p=<0.001). Patients with acute STEMI had greater QT interval dispersion compared to those with acute pericarditis (69.8 vs 50.6 ms, P<0.001), and showed QRS prolongation in ST-elevation leads.
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