ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute
Xianpei Wang1, Lifang Wei2, Ying Wu3
1Department of Cardiology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province, China. xianpeiwang@zzu.edu.cn.
Insights
ST-segment elevation (STE) in ST-segment elevation myocardial infarction (STEMI) predicts malignant ventricular arrhythmia events (MVAEs). Greater STE is a strong indicator of MVAEs, aiding in risk stratification for these dangerous cardiac events.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- ST-segment elevation (STE) is a marker of repolarization dispersion in ST-segment elevation myocardial infarction (STEMI).
- The predictive value of STE for malignant ventricular arrhythmia events (MVAEs) in STEMI patients is not well-established.
Purpose of the Study:
- To investigate the association between STE and the occurrence of MVAEs in STEMI patients.
- To determine if STE is a significant predictor of MVAEs.
Main Methods:
- 285 STEMI patients presenting within 6 hours of symptom onset were enrolled.
- Statistical analyses included t-test, chi-square test, binary multivariate logistic regression, and ROC curve analysis.
- MVAEs were defined as ventricular tachycardia or ventricular fibrillation.
Main Results:
- Patients with MVAEs had significantly greater STE compared to those without.
- STE was the strongest predictor of MVAEs (AUC = 0.905), with a cut-off value of 4.5 mV.
- Specific infarct-related arteries showed high predictive values for MVAEs.
Conclusions:
- STE is a powerful predictor of MVAEs in STEMI patients presenting within 6 hours of symptom onset.
- STE serves as an index for repolarization dispersion, reflecting cardiomyocyte status in both infarcted and non-infarcted areas.
- STE offers valuable risk stratification for MVAEs in STEMI.
Background:
ST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain.
Methods:
In total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis.
Results:
Patients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV.
Conclusions:
In patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.
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