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QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation
Hiroki Shiomi1, Masami Kosuge2, Takeshi Morimoto3
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Insights
The QRS score on an electrocardiogram (ECG) can predict heart attack size and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients. Higher scores indicate larger infarcts and increased risk, aiding early risk stratification.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) requires accurate prognostic tools.
- Electrocardiogram (ECG) parameters, like the QRS score, may offer insights into infarction progression.
- Predicting myocardial salvage post-reperfusion therapy is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between the QRS score on presentation ECG and infarct size in STEMI patients.
- To evaluate the relationship between QRS score and long-term mortality following primary percutaneous coronary intervention (PCI).
- To determine the utility of the QRS score for early risk stratification in STEMI.
Main Methods:
- A cohort of 2,607 STEMI patients undergoing primary PCI within 24 hours of symptom onset was analyzed.
- Patients were categorized into low (0-3), intermediate (4-7), and high (≥8) QRS score groups.
- Infarct size was estimated by peak creatine phosphokinase levels, and 5-year mortality was tracked.
Main Results:
- A significant positive correlation was observed between higher QRS scores and increased infarct size (P<0.001).
- Long-term mortality rates at 5 years increased progressively with higher QRS scores (15.6% to 23.7%, P<0.001).
- This association remained consistent across different infarct locations and was particularly pronounced in patients presenting early (≤2 hours).
Conclusions:
- Elevated QRS scores on presentation ECG are linked to larger infarct size and higher long-term mortality in STEMI patients treated with primary PCI.
- The QRS score serves as a valuable tool for early risk stratification in STEMI.
- This ECG-derived metric aids in identifying high-risk patients who may benefit from intensive management strategies.
Background:
In ST-segment elevation myocardial infarction (STEMI), QRS score at presentation ECG may reflect the progression of infarction and facilitate prediction of the degree of myocardial salvage achieved by reperfusion therapy.
Methods And Results:
Admission electrocardiogram (ECG) was studied in 2,607 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptom onset. Patients were classified into 3 groups according to QRS score: low (0-3, n=1,227), intermediate (4-7, n=810), and high (≥8, n=570). An increase of infarct size estimated by median peak creatine phosphokinase was observed as QRS score increased (low score, 1,836 IU/L; inter-quartile range (IQR), 979-3,190 IU/L; intermediate score, 2,488 IU/L; IQR, 1,126-4,640 IU/L; high score, 3,454 IU/L; IQR, 1,759-5,639 IU/L; P<0.001). Higher QRS score was associated with higher long-term mortality (low, intermediate, and high score, 15.6%, 19.7%, and 23.7% at 5 years, respectively; log-rank P<0.001). The positive relationship of QRS score with mortality was consistently seen when stratified by infarct location. The association of high QRS score with increased mortality was most remarkably seen in patients with early (≤2 h) presentation (low, intermediate, and high score: 16.7%, 16.6%, and 28.1% at 5 years, respectively; log-rank P<0.001).
Conclusions:
Higher QRS score at presentation ECG was associated with larger infarct size, and higher long-term mortality in patients with STEMI undergoing primary PCI. QRS score appears to be important in the early risk stratification for STEMI.