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Relationship between R-wave peak time and no-reflow in ST elevation myocardial infarction treated with a primary
Metin Çağdaş1, Süleyman Karakoyun, İbrahim Rencüzoğullari
1aDepartment of Cardiology, Kafkas University Medical Faculty bDepartment of Cardiology, Kars Harakani State Hospital, Kars cDepartment of Cardiology, Yedikule Chest Diseases and Chest Surgery Education and Research Center, Istanbul dDepartment of Cardiology, Gaziemir State Hospital, İzmir eDepartment of Cardiology, Ağri State Hospital, Ağri fDepartment of Cardiology, Elaziğ Education and Research Hospital, Elazig, Turkey.
Insights
Increased R-wave peak time (RWPT) is linked to coronary no-reflow (NR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). This finding offers a new diagnostic marker for NR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Markers
Background:
- Coronary no-reflow (NR) affects nearly half of ST-segment elevation myocardial infarction (STEMI) patients post-primary percutaneous coronary intervention (pPCI).
- Existing methods to define NR include TIMI grade, myocardial blush, and ST-segment resolution, but novel markers are needed.
- R-wave peak time (RWPT) is a potential, under-explored electrophysiological marker in STEMI.
Purpose of the Study:
- To investigate the association between R-wave peak time (RWPT) and the incidence of coronary no-reflow (NR).
- To evaluate RWPT as a predictor of NR in STEMI patients undergoing pPCI.
- To compare the predictive performance of RWPT with ST-segment resolution for NR.
Main Methods:
- A study population of 233 STEMI patients treated with pPCI was analyzed.
- Patients were categorized based on the development of NR.
- Preprocedural and postprocedural RWPT were measured from infarct-related artery leads and correlated with NR incidence.
Main Results:
- Increased preprocedural and postprocedural RWPT were significantly associated with the development of NR (p<0.001).
- Preprocedural RWPT emerged as an independent predictor of NR (OR: 1.254, p<0.001).
- Postprocedural RWPT demonstrated non-inferiority to ST-segment resolution percentage in predicting angiographic NR.
Conclusions:
- This study is the first to report a significant correlation between RWPT and NR in STEMI patients treated with pPCI.
- RWPT shows promise as a novel, accessible diagnostic marker for assessing no-reflow.
- Further research may validate RWPT for routine clinical use in STEMI management.
Objectives:
Coronary no-reflow (NR) is observed in nearly half of ST segment elevation myocardial infarction (STEMI) patients who undergo a primary percutaneous coronary intervention (pPCI) despite epicardial coronary vessel patency. Several methods used to define NR include thrombolysis in myocardial infarction grade, corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, ST-segment resolution, contrast echocardiography, and MRI. The aim of our study was to evaluate the relationship between NR and R-wave peak time (RWPT) measured from infarct-related artery leads METHOD: We enrolled 282 consecutive STEMI patients treated with pPCI in Kafkas University Hospital from January 2014 to January 2015. After exclusion, the remaining 233 patients were included in the study population RESULTS: Patients were divided into two groups according to the development of NR. We observed that increased preprocedural (31 (27-37) vs 27 (21-30) p<0,001) and postprocedural RWPT(35±7 vs 22±6 p<0,001) was associated with the development of NR and preprocedural RWPT(OR: 1.254 95% CI: 1.104-1.425 p<0,001) was found to be independent predictor of NR. The association between postprocedural RWPT and angiographic NR was statistically noninferior to that between ST-segment resolution % and NR(difference between area under curves: 0.0232, p= 0.38) CONCLUSION: the present study is the first to report a significant correlation between NR and RWPT in STEMI patients treated with primary pPCI.
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