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

Correlation of QRS duration with myocardial blush grade as a marker of myocardial reperfusion in primary percutaneous coronary intervention

Background

The association between duration of QRS and myocardial reperfusion is not very well established. Our aim was to assess the relationship between measurements of QRS duration and myocardial blush grade (MBG) in patients with ST-elevation myocardial infarction (STEMI) who were treated with a primary percutaneous coronary intervention (PCI).

Methods

Between January 2016 and June 2017, 200 patients with STEMI who presented within 12 h of symptom onset and taken up for primary PCI were analyzed with electrocardiogram (ECG) before and after the procedure. Two study groups were then defined on the basis of microvascular perfusion: group A (MBG 0-1) and group B (MBG 2-3).

Results

Group A had a total of 80 patients, and group B had 120 patients. The baseline characteristics were similar in the two groups. QRS duration was found to be longer in group A compared with group B at both the immediate ECG (95.5 ± 15.63 vs 80.87 ± 12.80 msec, p < 0.001, respectively) and at the 60th minute ECG (96.95 ± 16.2 vs 78.82 ± 12.08 msec, p < 0.001, respectively) post angioplasty. Significant difference was detected between the two groups post-angioplasty at both the immediate (10.99 ± 10.05 vs −6.64 ± 10.61 msec, p < 0.001) and the 60th minute (13.03 ± 11.64 vs −7.95 ± 11.11 msec, p < 0.001) ECG. Using receiver operator curve analysis, we found that QRS complex narrowing of 4.5 msec post angioplasty was the best cutoff value for predicting reperfusion.

Conclusion

QRS duration change post angioplasty is strongly correlated with the myocardial reperfusion in patients presenting with STEMI.

QRS duration: a novel marker of microvascular reperfusion as assessed by myocardial blush grade in ST elevation myocardial infarction patients undergoing a primary percutaneous intervention

Objectives

Prolonged QRS duration is a predictor of poor prognosis in patients with coronary artery disease. The association between the duration of QRS and myocardial reperfusion is not very well understood. Our aim was to assess the relationship between the measurements of QRS duration and myocardial blush grade (MBG) in patients with ST elevation myocardial infarction (STEMI) who were treated with a primary percutaneous intervention.

Patients and methods

A total of 213 patients (mean age: 57.5±11 years) with STEMI were included. ECG recordings were obtained for the evaluation of the QRS duration before and after primary percutaneous coronary intervention. Angiographic assessment in the infarct-related artery was performed using the MBG. Patients were categorized into two groups of those with impaired microvascular reperfusion (MBG: 0–1) and those with normal microvascular reperfusion (MBG: 2–3).

Results

Overall, 105 and 108 patients had an MBG of 0–1 or 2–3, respectively. There is no significant difference between patient’s characteristics. Despite the absence of a difference between two groups in terms of the QRS duration at presentation (P: 0.57), patients with impaired microvascular reperfusion were found to have longer QRS duration at immediately postprocedure (P: 0.003) and postprocedure 60 min time-points (P<0.001). Correlation analyses showed a positive correlation between pain-to-balloon time and QRS duration at postprocedure 60 min time-points (r: 0.137 and P: 0.04).

Conclusion

Our results suggest that longer QRS duration after angioplasty seemed to indicate the presence of impaired microvascular reperfusion in patients with STEMI.