title: High QRS score on admission strongly predicts impaired myocardial reperfusion in patients with a first anterior acute myocardial infarction.
abstract: BACKGROUND
  In patients with acute myocardial infarction (AMI), QRS score at presentation electrocardiogram (ECG) may reflect the evolutionary stage of the infarction and allow one to predict the degree of myocardial reperfusion potentially achievable by reperfusion therapy.
  
  
  RESULTS
  The relationship between QRS score on admission ECG and myocardial blush grade, an angiographic marker of myocardial reperfusion, was examined in 416 patients with a first anterior AMI who received reperfusion therapy within 6h after symptom onset. Patients were classified into 3 groups according to QRS score: 0 or 1 (n=102), 2-4 (n=228), and ≥5 (n=86). Higher QRS scores were associated with a longer time to admission, a greater ST-segment elevation, a higher frequency of impaired initial and final culprit coronary vessel flow, a higher peak creatine kinase level, and a higher frequency of impaired myocardial reperfusion as defined by myocardial blush grade 0/1 on the final angiogram. Multivariate analysis showed that a high QRS score ≥5 was the strongest predictor of impaired myocardial reperfusion (odds ratio 20.3, P<0.001). These findings were similar when the data were stratified according to time to admission (≤2h, >2h).
  
  
  CONCLUSIONS
  In patients with a first anterior AMI treated by reperfusion therapy, admission high QRS score ≥5 strongly predicts impaired myocardial reperfusion, even when presentation is early (≤2h).
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minamiku, Yokohama 232-0024, Japan. masami-kosuge@pop06.odn.ne.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ebina
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iwahashi
authors.forename: Kengo
authors.initials: K
authors.lastname: Tsukahara
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Endo
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Maejima
authors.forename: Katsutaka
authors.initials: K
authors.lastname: Hashiba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome