Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation
Akihiro Kobayashi1, Naoki Misumida1, Shunsuke Aoi1
1Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
Insights
Low QRS voltage in ST-segment elevation myocardial infarction (STEMI) is linked to multi-vessel disease (MVD). This finding suggests low voltage may indicate more complex coronary artery disease requiring intervention.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Diagnostics
Background:
- Low QRS voltage historically predicted poor outcomes in acute myocardial infarction (AMI).
- The relationship between low QRS voltage and angiographic findings in AMI remains underexplored.
Purpose of the Study:
- To investigate the association between low QRS voltage and angiographic findings in patients with anterior ST-segment elevation myocardial infarction (STEMI).
Main Methods:
- Retrospective analysis of 190 patients with anterior STEMI.
- Low QRS voltage defined as <1.0mV (precordial leads) or <0.5mV (limb leads).
- Correlation with angiographic findings, specifically multi-vessel disease (MVD).
Main Results:
- 19% of patients (37/190) exhibited low QRS voltage.
- Low voltage group had significantly higher rates of MVD (76% vs. 52%, p=0.01).
- Low voltage independently predicted MVD (OR 2.50; 95% CI 1.12-6.03; p=0.032) and was associated with in-hospital coronary artery bypass grafting (CABG).
Conclusions:
- Low QRS voltage is associated with multi-vessel disease in anterior STEMI.
- This association may indicate more extensive coronary artery disease.
- Low voltage could serve as a marker for patients requiring further investigation or intervention.
Background:
Low QRS voltage was reported to predict adverse outcomes in acute myocardial infarction in the pre-thrombolytic era. However, the association between low voltage and angiographic findings has not been fully addressed.
Methods:
We performed a retrospective analysis of patients with anterior ST-segment elevation myocardial infarction (STEMI). Low QRS voltage was defined as either peak to peak QRS complex voltage <1.0mV in all precordial leads or <0.5mV in all limb leads.
Results:
Among 190 patients, 37 patients (19%) had low voltage. Patients with low voltage had a higher rate of multi-vessel disease (MVD) (76% vs. 52%, p=0.01). Patients with low voltage were more likely to undergo coronary artery bypass grafting (CABG) during admission (11% vs. 2%, p=0.028). Low voltage was an independent predictor for MVD (OR 2.50; 95% CI 1.12 to 6.03; p=0.032).
Conclusion:
Low QRS voltage was associated with MVD and in-hospital CABG in anterior STEMI.
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