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R wave peak time and no reflow following primary percutaneous coronary intervention: Immediate and short-term
Jamal Yusuf1, Purneshwar Kumar Pandey1, Vimal Mehta1
1Department of Cardiology, D.M. Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India.
Insights
R wave peak time (RWPT) measured before and after primary percutaneous coronary intervention (PCI) can predict no-reflow (NR) in ST-elevation myocardial infarction (STEMI) patients. Persistently increased RWPT after PCI indicates NR and is linked to worse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- No-reflow (NR) is a significant complication in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- Current electrocardiogram (ECG) parameters for assessing NR are often postprocedural.
- R wave peak time (RWPT) is a dynamic ECG parameter reflecting myocardial conduction delay.
Purpose of the Study:
- To evaluate preprocedural and postprocedural RWPT as predictors of NR.
- To assess the association of RWPT with immediate and short-term clinical outcomes in STEMI patients undergoing primary PCI.
Main Methods:
- 200 STEMI patients undergoing primary PCI were analyzed.
- ECG parameters, including RWPT, and angiographic data were recorded pre- and post-procedure.
- Patients were followed for 6 months for clinical outcomes.
Main Results:
- 35% of patients experienced NR.
- Independent predictors of NR included age, thrombus burden, symptom-to-balloon time, and baseline RWPT.
- An increase in RWPT post-PCI was a highly sensitive and specific marker for persistent NR.
- Increased RWPT post-PCI correlated with worse short-term cardiovascular outcomes.
Conclusions:
- Baseline RWPT is a significant predictor of NR in STEMI patients undergoing primary PCI.
- Persistently elevated RWPT after primary PCI is a sensitive and specific ECG marker for NR.
- Increased RWPT post-PCI is associated with adverse short-term clinical outcomes.
Background:
No reflow (NR) remains an important constraint in management of ST elevation myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Most ECG parameters validated till date including ST resolution are postprocedural. R wave peak time (RWPT) is a dynamic parameter and reflects conduction delay in ischaemic myocardium in selected leads supplied by infarct related artery (IRA). The present study was undertaken to see whether preprocedural RWPT per se or RWPT following primary PCI can predict persistence of NR along with immediate and short-term clinical outcome.
Methods:
200 patients were enrolled after exclusion. Clinical, Biochemical, ECG parameters including RPWT and angiographic parameters (pre- and post-procedure) were recorded. ECG papers was analysed using digital image processing software (http://imagej.nih.gov/ij/). All patients were followed up for 6 months.
Results:
NR was observed in 35% of the patients. Age, Diabetes, symptom to balloon time, higher thrombus burden, peak CPK-MB level (pre and post procedure) were significantly higher in NR group. On ECG analysis, baseline RWPT, QRS duration and pathological Q wave were significantly higher in NR group. On multivariate analysis, age (OR 1.10 CI 1.00-1.21 P = 0.04), thrombus grade ≥ 3 in IRA (OR 12.38 CI 2.08-73.58 P = 0.006), symptom to balloon time (OR 2.18 CI 1.6-3.0 P < 0.001) and baseline RWPT on ECG [OR 1.86 CI 1.24-2.78, P = 0.003] were found to be independent predictors of NR. Increase in RWPT following primary PCI was found to both highly sensitive and specific for diagnosing persistence of NR after primary PCI. Follow up at the end of 6 months has shown that patients with increased RWPT following primary PCI had worse short-term cardiovascular outcomes compared to those with decreased RWPT following primary PCI.
Conclusion:
Baseline RWPT is a significant predictor of NR in patients of STEMI undergoing primary PCI. A persistently increased RWPT following primary PCI is also a highly sensitive and specific ECG marker of persistence of NR which is associated with adverse short-term clinical outcome.
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