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Published on: May 28, 2019
The effect of ST resolution on QT dispersion after interventional treatment in acute myocardial infarction
Erdoğan Ilkay1, Mustafa Yavuzkir, Ilgin Karaca
1Department of Cardiology, Firat University, School of Medicine, Elaziğ, Turkey. ilkayerdoğan@superonline.com
Insights
Reperfusion treatment for acute myocardial infarction (AMI) reduces QT dispersion (QTD). Full ST resolution after angioplasty further improves myocardial electrical stability, indicating better tissue perfusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Reperfusion therapy in acute myocardial infarction (AMI) is known to reduce QT dispersion (QTD).
- Successful myocardial perfusion, indicated by Thrombolysis in Myocardial Infarction (TIMI) III flow, is crucial.
- ST-resolution after primary angioplasty correlates with left ventricular function, enzyme elevation, and mortality in AMI.
Purpose of the Study:
- To investigate the relationship between ST-resolution grade and QTD in patients with AMI.
- To assess if QTD can determine successful myocardial tissue perfusion after interventional treatment for AMI.
- To evaluate the impact of TIMI III flow on QTD and myocardial electrical stability.
Main Methods:
- The study included 57 patients diagnosed with anterior AMI with ST elevation.
- Patients underwent primary angioplasty to restore Thrombolysis in Myocardial Infarction (TIMI) III flow in the infarct-related artery (IRA).
- Electrocardiograms were taken post-procedure, and patients were grouped based on ST-resolution grade (full, partial, unsuccessful).
Main Results:
- A significant reduction in corrected QT dispersion (QTcD) was observed in all groups post-procedure.
- Full ST resolution showed a statistically significant greater reduction in QTcD compared to partial and unsuccessful resolution.
- No significant differences were found in risk factors, procedural times, or pre-procedure QTcD among the groups.
Conclusions:
- Thrombolysis in Myocardial Infarction (TIMI) III flow effectively reduces QT dispersion (QTD) in acute myocardial infarction (AMI).
- Achieving full myocardial perfusion, evidenced by complete ST-resolution, provides an additional benefit in enhancing myocardial electrical stability.
- QTcD can serve as an indicator of myocardial tissue perfusion quality post-reperfusion therapy.
Background:
It has been reported that reperfusion treatment reduces QT dispersion (QTD) in cases of acute myocardial infarction (AMI). Successful myocardial perfusion is not synonymous with Thrombolysis in Myocardial Infarction (TIMI) III flow. It has been demonstrated that in AMI, the grade of ST-resolution correlates strongly with left ventricular (LV) function, enzyme elevation, and mortality after primary angioplasty.
Hypothesis:
This study investigated the relation between ST-resolution grade and QTD and the feasibility of using QTD as a determinant of successful myocardial tissue perfusion in patients in whom TIMI III flow in the infarct-related artery (IRA) is restored by interventional treatment for AMI.
Methods:
The study included 57 patients (38 men, 19 women, average age 54.4 +/- 11.6 years), whose IRA was perfused by primary angioplasty after the diagnosis of anterior AMI with ST elevation. Electrocardiograms of patients were taken 45 +/- 12 min post procedure, and patients were divided into three groups depending on the grade of ST resolution: Group 1, full ST resolution; Group 2, partial ST resolution; and Group 3, unsuccessful ST resolution.
Results:
Full ST resolution was seen in 19 cases (33%), partial resolution in 26 cases (47%), and unsuccessful resolution in 12 cases (20%). There were no differences among groups in terms of risk factors, stent diameters, symptom onset-balloon time, LV function, and preprocedure corrected QTD (QTcD) (p = 0.274). After the procedure, a significant reduction in QTcD was found within the groups (p = 0.0001 in Group 1, p = 0.004 in Group 2, and p = 0.011 in Group 3). Reductions in QTcD post procedure were 24.21 +/- 14.27, 11.85 +/- 16.18, and 12.50 +/- 11.58 ms in Groups 1, 2, and 3, respectively. There was a statistically significant difference of p = 0.015 between Groups 1 and 2 and a difference of p = 0.028 between Groups 1 and 3. There was no statistically significant difference between Groups 2 and 3 (p = 0.916).
Conclusion:
In acute MI, TIMI III flow led to a reduction in QTcD, and full myocardial perfusion made an additional contribution to the electrical stability of the myocardium.
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