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P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow
Metin Çağdaş1, Süleyman Karakoyun1, İbrahim Rencüzoğulları1
1Kafkas University Medical Faculty, Department of Cardiology, Kars, Turkey.
Insights
P wave peak time (PWPT) measured on ECG can predict coronary no-reflow (NR) in ST-segment elevation myocardial infarction (STEMI) patients before primary percutaneous coronary intervention (pPCI). This finding may improve patient outcomes by identifying those at risk for NR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Electrocardiography
Background:
- Coronary no-reflow (NR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) is linked to poorer prognosis.
- Predicting NR before pPCI remains challenging, despite advancements in cardiovascular interventions.
- Previous studies on P wave duration (PWD) and dispersion (PWDIS) in STEMI patients showed associations with reperfusion success but not NR prediction.
Purpose of the Study:
- To evaluate the predictive value of P wave duration (PWD), P wave dispersion (PWDIS), and a novel parameter, P wave peak time (PWPT), for NR development in STEMI patients.
- To determine if PWPT can predict NR before pPCI.
Main Methods:
- Fifty-six patients with anterior STEMI were included.
- P wave parameters (PWD, PWDIS, PWPT) were calculated from admission ECGs and 60 minutes post-pPCI.
- Patients were categorized into NR and reflow groups based on outcomes.
Main Results:
- P wave peak time (PWPT) in leads D2 (PWPTD2) and V1 (PWPTV1) was significantly longer in the NR group compared to the reflow group.
- PWPT demonstrated significant correlations with reperfusion markers, including ST-segment resolution, peak CKMB levels, and TIMI frame count.
- Preprocedural PWPTD2 emerged as an independent predictor of NR development.
Conclusions:
- P wave peak time (PWPT) is a potentially valuable parameter for assessing reperfusion success and predicting coronary no-reflow (NR) in STEMI patients.
- Preprocedural measurement of PWPT may aid in identifying patients at high risk for NR, allowing for tailored interventions.
Objectives:
Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS, respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients.
Method:
Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI.
Results:
Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development.
Conclusion:
In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development.
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