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Yang N, Han X, Zhang J, Zhang S, Sun J. What can we find in QRS in patients with ST-segment-elevation myocardial infarction? J Electrocardiol 2022. [DOI: 10.1016/j.jelectrocard.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Díaz-Munoz R, Valle-Caballero MJ, Sanchez-Gonzalez J, Pizarro G, García-Rubira JC, Escalera N, Fuster V, Fernández-Jiménez R, Ibanez B. Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study. Basic Res Cardiol 2021; 116:45. [PMID: 34279726 DOI: 10.1007/s00395-021-00884-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
Besides its protective effect against neutrophil-mediated injury at reperfusion, intravenous (IV) metoprolol was recently shown to reduce the progression of ischemic injury in a pig model of ST-segment elevation myocardial infarction (STEMI). Here, we tested the hypothesis that IV metoprolol administration in humans with ongoing STEMI blunts the time‑dependent progression of ischemic injury assessed by serial electrocardiogram (ECG) evaluations before reperfusion. The METOCARD-CNIC trial randomized 270 anterior STEMI patients to IV metoprolol or control before reperfusion by percutaneous coronary intervention (PCI). In 139 patients (69 IV metoprolol, 70 controls), two ECGs were available (ECG-1 before randomization, ECG-2 pre-PCI). Between-group ECG differences were analyzed using univariate and multivariate regression models. No significant between-group differences were observed on ECG-1. On ECG-2, patients who received IV metoprolol had a narrower QRS than those in the control group (84 ms vs. 90 ms, p = 0.029), a lower prevalence of QRS distortion (10% vs. 26%, p = 0.017), and a lower sum of anterior and total ST-segment elevation (10.1 mm vs. 13.6 mm, p = 0.014 and 10.4 mm vs. 14.0 mm, p = 0.015, respectively). Adjusted analysis revealed similar results. Significant associations were observed between ECG-2 variables and cardiac magnetic resonance imaging measurements (extent of myocardial edema, infarct size, microvascular obstruction, and left-ventricular ejection fraction) after STEMI. In summary, IV metoprolol administration before reperfusion ameliorates ECG markers of myocardial ischemia in anterior STEMI patients. These data confirm that IV metoprolol is able to reduce ischemic injury and highlight the ability of ECG analysis to provide relevant real-time information on the effect of cardioprotective therapies before reperfusion.
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Affiliation(s)
- Raquel Díaz-Munoz
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | | | | | - Gonzalo Pizarro
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain.,CIBER de Enfermedades CardioVasculares, Madrid, Spain.,Ruber Juan Bravo Quironsalud Hospital UEM, Madrid, Spain
| | | | - Noemi Escalera
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain.,CIBER de Enfermedades CardioVasculares, Madrid, Spain
| | - Valentin Fuster
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain.,Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Rodrigo Fernández-Jiménez
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain. .,CIBER de Enfermedades CardioVasculares, Madrid, Spain. .,Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Borja Ibanez
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain. .,CIBER de Enfermedades CardioVasculares, Madrid, Spain. .,Department of Cardiology, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain.
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Ilkay E, Kacmaz F, Maden O, Aksu T, Selcuk MT, Erbay AR, Demir AD. A new electrocardiographic marker of myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous intervention: the value of QRS duration. EUROINTERVENTION 2012; 7:1406-12. [PMID: 22522551 DOI: 10.4244/eijv7i12a220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Although ischaemia-induced QRS complex changes have been described previously, their relation with reperfusion status is not clear. We aimed to investigate the relation of QRS duration with reperfusion at tissue level compared to myocardial blush in patients with acute myocardial infarction who underwent successful primary percutaneous coronary angioplasty. METHODS AND RESULTS One hundred and forty-eight patients were enrolled. Based on the post-angioplasty myocardial blush grade (MBG), patients were divided into reperfusion (grades 2 and 3) and impaired reperfusion (grades 0 and 1) groups. Although the two groups did not differ in terms of admission QRS duration (81±17 vs. 79±15 msec, p=0.473), the patients in the impaired reperfusion group had a significantly longer QRS duration both at immediate post-angioplasty (78±18 vs. 68±17 msec, p=0.001) and at the 60th minute ECG (77±17 vs. 60±17 msec, p<0.001). Patients in the impaired reperfusion group revealed significantly less narrowing of QRS duration in the post-angioplasty 60th minute ECG (6±5 vs. 20±5 msec, p<0.001) when compared to the patients in the reperfusion group. After adjusting all variables, QRS narrowing in the 60th minute ECG was determined as an independent electrocardiographic predictor of reperfusion (OR:1.39, 95% CI: 1.25-1.54, p<0.001). CONCLUSIONS We demonstrated that QRS duration is a strong indicator of myocardial reperfusion status.
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Affiliation(s)
- Erdogan Ilkay
- Department of Cardiology, TOBB ETÜ Hospital, Ankara, Turkey
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Zhang Q, Zhang RY, Hu J, Yang ZK, Zhang JS, Ding FH, Du R, Zhu ZB, Shen WF. Partial vs full coverage for tandem lesions in culprit vessel during primary coronary intervention in patients with acute ST-elevation myocardial infarction--the PERFECT-AMI study. Circ J 2009; 73:2236-43. [PMID: 19822979 DOI: 10.1253/circj.cj-09-0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The efficacy of partial vs full coverage for tandem lesions in the culprit vessel during primary percutaneous coronary intervention (PCI) after ST-elevation myocardial infarction (STEMI) was compared in the present study. METHODS AND RESULTS The 76 patients with STEMI and tandem lesions in the culprit vessel were randomized to receive stent implantation for an occluded/culprit lesion only (partial group) or complete coverage of lesions (full group). After PCI, patients in the partial group had more complete ST-segment resolution (STR) at 90 min (60.5% vs 28.9%, P=0.006), Thrombosis In Myocardial Infarction (TIMI) flow grade 3 (68.4% vs 28.9%, P=0.001), and myocardial blush grade 3 (42.1% vs 15.8%, P=0.04) than those in the full group. At 6 months, the major adverse cardiac events-free survival rate did not differ significantly between groups, but left ventricular (LV) ejection fraction was improved in the partial group. Multivariate analysis revealed pre-procedural TIMI flow grade >1 and door-to-balloon time <90 min were positively associated with complete STR at 90 min, whereas full coverage for tandem lesions was an independent factor for poor STR (odds ratio 2.58, 95% confidence interval 1.08-5.42, P=0.03). CONCLUSIONS For acute STEMI patients with tandem lesions in the culprit vessel, primary stenting for the occluded lesion only is beneficial in improving myocardial perfusion and LV function.
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Affiliation(s)
- Qi Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Kosuge M, Ebina T, Hibi K, Morita S, Komura N, Hashiba K, Kiyokuni M, Nakayama N, Umemura S, Kimura K. Early, Accurate, Non-Invasive Predictors of Left Main or 3-Vessel Disease in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Circ J 2009; 73:1105-10. [DOI: 10.1253/circj.cj-08-1009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masami Kosuge
- The Division of Cardiology, Yokohama City University Medical Center
| | - Toshiaki Ebina
- The Division of Cardiology, Yokohama City University Medical Center
| | - Kiyoshi Hibi
- The Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Morita
- The Division of Cardiology, Yokohama City University Medical Center
| | - Naohiro Komura
- The Division of Cardiology, Yokohama City University Medical Center
| | | | | | - Naoki Nakayama
- The Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Umemura
- The Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- The Division of Cardiology, Yokohama City University Medical Center
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