Predischarge QRS score and risk for heart failure after first ST-elevation myocardial infarction
Andreas P Kalogeropoulos1, John A Chiladakis, Ilias Sihlimiris
1Division of Cardiology, University of Patras Medical School, Patras, Greece. riondoc@otenet.gr
Insights
The QRS score, an index of infarct size, predicts short-term outcomes after ST-elevation myocardial infarction. A score below 3 indicates a lower risk of death or heart failure hospitalization.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Diagnostics
Background:
- The prognostic value of the QRS score for infarct size is understudied in the current reperfusion era.
- ST-elevation myocardial infarction (STEMI) remains a critical cardiovascular event.
Purpose of the Study:
- To evaluate the prognostic utility of the QRS score in predicting short-term outcomes after a first STEMI.
- To assess the QRS score's ability to predict mortality and heart failure hospitalization.
Main Methods:
- Prospective follow-up of 100 STEMI survivors for 3 months.
- Calculation of a modified 32-point QRS score at hospital discharge.
- Primary endpoint: composite of death or heart failure hospitalization.
Main Results:
- A QRS score ≥ 3 was associated with significantly higher event rates (44.7% vs. 8.2%, P < .001).
- All six deaths occurred in patients with a QRS score ≥ 3 (P = .002).
- A QRS score < 3 demonstrated a 91.9% negative predictive value for heart failure-free survival.
Conclusions:
- The predischarge QRS score is a powerful predictor of short-term outcomes in STEMI survivors.
- The QRS score effectively identifies patients at high risk for mortality and heart failure readmission.
Background:
The prognostic value of the QRS score, a simple index of infarct size after a first ST-elevation myocardial infarction, has not been adequately explored in the reperfusion era.
Methods And Results:
We prospectively followed up 100 consecutive survivors of a first ST-elevation myocardial infarction (aged 64 +/- 13 years, 77% were male) without bundle branch block or paced rhythm at hospital discharge for 3 months. The modified 32-point QRS score was calculated as part of the predischarge evaluation. The predefined primary endpoint was the composite of death or hospitalization for heart failure. By 3 months, 6 patients died and 16 patients were readmitted for heart failure, resulting in a 22% primary endpoint rate. Patients with a QRS score >/= 3 at hospital discharge (n = 38) had significantly more events compared with those with a QRS score < 3 (44.7% vs. 8.2%, P < .001), and all six deaths occurred among patients with a QRS score >/= 3 (P = .002). A QRS score < 3 reliably predicted heart-failure free survival during the follow-up period (negative predictive value 91.9%). In multivariate models, the QRS score was an independent predictor of the primary endpoint (hazard ratio = 1.4 per point, 95% confidence interval 1.1-1.8, P = .003).
Conclusion:
For patients surviving a first ST-elevation myocardial infarction, the predischarge QRS score provides powerful prognostic information on short-term outcomes, including mortality and readmission for heart failure.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Acute Coronary Syndrome IV: Interprofessional Care