Level of Selvester QRS score is predictive of ST-segment resolution and 30-day outcomes in patients with acute myocardial infarction undergoing primary coronary intervention.
BACKGROUND
The presence of Q waves at presentation with a first acute ST-segment elevation myocardial infarction (STEMI) reflects a more advanced stage of the infarction. Resolution of ST-segment elevation indicating successful myocyte reperfusion may differ according to how far the infarction process has progressed. The Selvester QRS score measures infarct size. The purpose of this study was to evaluate the predictive value of QRS score on ST-segment resolution and 30-day clinical outcomes in patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI).


METHODS
We conducted a prospective cohort study in 112 consecutive patients (mean age 57 +/- 11 years, 94 men, 18 women) with first acute STEMI of <12-hour onset who underwent successful (TIMI-3 flow) primary PCI. The Selvester QRS score was estimated on the first electrocardiogram (ECG) after hospital admission. Sum of ST-segment elevation amount in millimeters was obtained immediately before angioplasty and 60 minutes after the restoration of TIMI-3 flow. The difference between 2 measurements was accepted as the amount of ST-segment resolution and expressed as summation sigmaSTR. summation sigmaSTR <50% was accepted as ECG sign of no-reflow phenomenon. Follow-up to 30-day was performed.


RESULTS
The no-reflow phenomenon was more often observed in patients with high QRS score (> or = 4) than in those with low QRS score (34.4% and 6.3%, P < .001). Thirty-day composite major adverse cardiac event (MACE) rate was 14% in patients with high QRS score versus 0% in low QRS score group (P = .007). After adjusting for baseline characteristics, high QRS score remained a strong independent predictor of no-reflow (OR 4.1, 95% CI 1.5-10.7, P = .005) and MACE (OR 1.8, 95% CI 1.1-2.9, P = .011).


CONCLUSIONS
The presence of high QRS score is an independent predictor of incomplete ST recovery and 30-day MACE in STEMI treated with primary PCI.
Uyarel
Huseyin
H
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey. uyarel@yahoo.com
Cam
Nese
N
Okmen
Ertan
E
Kasikcioglu
Hulya
H
Tartan
Zeynep
Z
Akgul
Ozgur
O
Simsek
Dilek
D
Cetin
Mustafa
M
Bozbeyoglu
Emrah
E
Buturak
Ali
A
Uzunlar
Bulent
B
D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome