Key result
Terminal QRS distortion in anterior AMI links to ~51% larger infarct size and less residual flow.
Why the study?
Does terminal QRS complex distortion on admission predict reduced residual flow and larger infarct size in patients with anterior AMI undergoing primary angioplasty?
Observational (n=46)
Single-blind
No
Does terminal QRS complex distortion on admission predict reduced residual flow and larger infarct size in patients with anterior AMI undergoing primary angioplasty?
Absolute Event Rate: 40.8% vs 27.1%
p-value: p=<0.05
Terminal QRS complex distortion on admission ECG in anterior AMI is a simple predictor of less residual flow, larger risk area, and greater final infarct size.
May aid admission ECG risk stratification in anterior AMI; leaves open whether it should guide reperfusion strategy.
BACKGROUND: Terminal QRS complex distortion on admission is a simple and reliable predictor of infarct size in patients with acute myocardial infarction (AMI). It is uncertain, however, whether this reflects reduced myocardial perfusion of the infarct area and a larger area of the myocardium at risk. This study was conducted to investigate whether terminal QRS distortion complex on admission is a reliable predictor of reduced residual flow and a larger area of the myocardium at risk compared to patients who are admitted without a terminal QRS distortion. METHODS: We evaluated the relationship between terminal QRS complex distortion and residual flow to the infarct zone and risk area in 46 anterior AMI patients undergoing primary angioplasty. (99m)Tc-sestamibi imaging was performed at baseline and 5-9 days after angioplasty. The study population was divided into those with (Group I, n=16) and without (Group II, n=30) terminal QRS complex distortion. RESULTS: Baseline characteristics were similar between the two groups. The area of the myocardium at risk was higher in Group I (59.9 +/- 15.3%) than in Group 11 (48.6 +/- 13.7%, p < 0.05; mean+SD) while the nadir measurement of the residual flow was lower in Group I (0.10 +/- 0.07) than in Group 11 (0.16 +/- 0.09, p < 0.05). Although the final infarct size was significantly higher in Group I (40.8 +/- 17.2%) than in Group 11 (27.1 +/- 18.1%, p < 0.05), the myocardial salvage index did not differ significantly between the two groups. CONCLUSION: Terminal QRS complex distortion seems to be associated with less residual flow to the infarct zone, a larger risk area and greater infarct size in patients with anterior AMI.
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Yang et al. (2005) conducted an observational in Anterior Acute Myocardial Infarction (n=46). Terminal QRS complex distortion on admission electrocardiogram vs. Absence of terminal QRS complex distortion was evaluated on Final infarct size (% of the left ventricle) (p=<0.05). Terminal QRS complex distortion on admission in patients with anterior acute myocardial infarction was associated with a significantly larger final infarct size (40.8% vs 27.1%) and less residual flow.