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Relationship of Frontal QRS-T Angle with Coronary Flow Grade and Adverse Events Before Percutaneous Coronary
Uğur Küçük1, Kadir Arslan1, Uğur Özpınar1
1Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Türkiye.
Insights
The frontal QRS-T angle, an electrocardiography measure, predicts coronary blood flow and adverse events in non-ST-elevation myocardial infarction patients. A wider angle indicates poorer flow and higher risk, aiding early intervention decisions.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Electrocardiography (ECG) is crucial for risk stratification in non-ST-elevation myocardial infarction (NSTEMI).
- The frontal QRS-T angle, an ECG parameter, may reflect coronary blood flow alterations.
Purpose of the Study:
- To investigate the association between the frontal QRS-T angle and coronary blood flow grade.
- To explore the relationship between the frontal QRS-T angle and adverse events in NSTEMI patients.
Main Methods:
- 191 NSTEMI patients were categorized by Thrombolysis in Myocardial Infarction (TIMI) flow grade (0/1 vs. 2/3) via coronary angiography.
- Frontal QRS-T angle was measured before revascularization and correlated with TIMI flow and in-hospital adverse events.
Main Results:
- Patients with TIMI 0/1 flow exhibited a significantly wider frontal QRS-T angle compared to those with TIMI 2/3 flow (P < 0.001).
- The frontal QRS-T angle independently predicted both lower TIMI flow grade (OR: 1.51) and adverse events (OR: 1.11) in NSTEMI patients.
- A cut-off value of 73.5° for the frontal QRS-T angle was identified for predicting TIMI flow and adverse events.
Conclusions:
- An elevated frontal QRS-T angle serves as a valuable ECG marker for assessing coronary blood flow severity in NSTEMI.
- This parameter can help identify patients who may benefit from an early invasive strategy, improving risk assessment and management.
Objective:
Electrocardiography is used in the initial risk assessment of patients with non-ST-elevation myocardial infarction. The frontal QRS-T angle is an electrocardiography parameter that may be affected by the alterations in the coronary blood flow. This study aimed to explore the relationship of the frontal QRS-T angle with coronary flow grade and adverse events in non-ST-elevation myocardial infarction patients.
Methods:
A total of 191 non-ST-elevation myocardial infarction patients were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow level on coronary angiography before revascularization, namely TIMI 0/1 and TIMI 2/3. The frontal QRS-T angle obtained before revascularization was compared between the groups and its relationship with adverse events was examined. In-hospital all-cause mortality, repeat target lesion revascular-ization, new-onset heart failure, ventricular arrhythmias, and atrial fibrillation were defined as adverse events.
Results:
Frontal QRS-T angle was wider in the patients with TIMI 0/1 flow compared to the patients with TIMI 2/3 flow (P < 0.001). The frontal QRS-T angle was determined to be a predictor of TIMI flow grade 0/1 before revascularization in patients with non-ST-elevation myocardial infarction (odds ratio: 1.51; 95% CI: 1.30-1.75; P < 0.001). The frontal QRS-T angle was a predictor of the adverse events during hospitalization in the patients with non-ST-elevation myocardial infarction (odds ratio: 1.11; 95% CI: 1.04-1.19; P = 0.002). The cut-off values of the frontal QRS-T angle for TIMI flow grade and adverse events were determined to be 73.5°, based on receiver operating characteristic curve analysis.
Conclusion:
Increased frontal QRS-T angle may be a useful electrocardiography parameter for determining TIMI flow grade and the need for an early invasive strategy in patients with non-ST-elevation myocardial infarction.
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