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Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction
Divan Gabriel Topal1, Lars Nepper-Christensen1, Jacob Lønborg1
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
Insights
Electrocardiogram (ECG) scores show limited utility in guiding treatment for late STEMI presenters. Early Q waves and a low AW-score weakly correlate with infarct size but not myocardial salvage, deeming them insufficient for clinical decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Clinical decision-making for ST-segment elevation myocardial infarction (STEMI) patients presenting late (beyond 12 hours) is challenging.
- Electrocardiogram (ECG) findings may offer valuable insights in these cases.
- This study evaluates ECG scores' association with myocardial salvage and infarct size in late STEMI presenters undergoing primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the association between three ECG scores and myocardial salvage and infarct size.
- To determine if ECG scores can aid clinical decision-making in late STEMI presenters.
- To assess the predictive value of early Q waves, AW-score, and Sclarovsky-Birnbaum Ischemia Grading System scores.
Main Methods:
- Sixty-six STEMI patients with ongoing symptoms presenting 12-72 hours post-onset were included.
- Cardiac magnetic resonance (CMR) was performed at day 1 and day 93.
- Pre-PCI ECGs were analyzed for early Q waves, Anderson-Wilkins (AW) acuteness score, and classic/modified Sclarovsky-Birnbaum (SB-IG) scores.
Main Results:
- Early Q waves correlated with larger myocardium at risk and final infarct size, but not significantly with myocardial salvage.
- An AW-score < 3 showed a trend towards larger infarct size but was not associated with the salvage index.
- Classic and modified SB-IG scores showed no significant association with infarct size or myocardial salvage.
Conclusions:
- Only early Q waves and AW-score < 3 demonstrated a limited association with myocardium at risk and infarct size.
- The association with myocardial salvage was weak for these ECG scores.
- Current ECG scores are insufficient to guide clinical decisions in late STEMI presenters with ongoing symptoms.
Background:
Clinical decision-making in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 h of symptom onset (late presenters) is challenging. However, the electrocardiogram (ECG) may provide helpful information. We investigated the association between three ECG-scores and myocardial salvage and infarct size in late presenters treated with primary percutaneous coronary intervention (primary PCI).
Methods:
Sixty-six patients with STEMI and ongoing symptoms presenting 12-72 h after symptom onset were included. Cardiac magnetic resonance was performed at day 1 (interquartile range [IQR], 1-1) and at follow-up at day 93 (IQR, 90-98). The pre-PCI ECG was analyzed for the presence of pathological QW (early QW) as well as Anderson-Wilkins acuteness score (AW-score), the classic Sclarovsky-Birnbaum Ischemia Grading System (classic SB-IG-score) and a modified SB-IG-score including any T-wave morphologies.
Results:
Early QW was associated with a larger myocardium at risk (39 ± 12 versus 33 ± 12; p = 0.030) and final infarct size (20 ± 11 versus 14 ± 9; p = 0.021) as well as a numerical lower final myocardial salvage (0.52 ± 0.19 versus 0.61 ± 0.23; p = 0.09). The association with final infarct size disappeared after adjusting for myocardium at risk. An AW-score < 3 showed a trend towards a larger final infarct size (18 ± 11 versus 11 ± 11; p = 0.08) and was not associated with salvage index (0.55 ± 0.20 versus 0.65 ± 0.30; p = 0.23). The classic and modified SB-IG-score were not associated with final infarct size (modified SB-IG-score, 17 ± 10 versus 21 ± 13; p = 0.28) or final myocardial salvage (0.53 ± 0.20 versus 0.53 ± 0.26; p = 0.96).
Conclusion:
Of three well-established ECG-scores only early QW and AW-score < 3 showed association with myocardium at risk and infarct size to some extent, but the association with myocardial salvage was weak. Hence, neither of the three investigated ECG-scores are sufficient to guide clinical decision-making in patients with STEMI and ongoing symptoms presenting beyond 12 h of symptom onset.
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