The Predictive Value of R Wave Peak Time to Detect Thrombus Burden in St-segment Elevation Myocardial Infarction: A
Zehra Güven-Çetin1, Bekir Demirtaş2, Ahmet Balun3
1Department of Cardiology, Ankara City Hospital, Ankara.
Insights
R wave peak time (RWPT) on ECG can predict high thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients before angiography. Longer RWPT indicates a higher likelihood of significant thrombus, aiding in procedural risk assessment.
Area of Science:
- Cardiology
- Medical Diagnostics
- Interventional Cardiology
Background:
- Higher thrombus burden in acute ST-segment elevation myocardial infarction (STEMI) is linked to increased procedural complications and adverse cardiac events.
- Early identification of high thrombus burden (HTB) is crucial for optimizing intervention strategies and patient outcomes.
Purpose of the Study:
- To investigate the utility of R wave peak time (RWPT) on electrocardiogram (ECG) as a non-invasive predictor of thrombus burden before coronary angiography in STEMI patients.
- To establish a correlation between RWPT measurements and angiographically assessed thrombus burden.
Main Methods:
- A cohort of 159 STEMI patients undergoing coronary angiography were analyzed.
- Thrombus burden was quantified using the Thrombolysis in Myocardial Infarction (TIMI) thrombus scale, categorizing grades 0-3 as low and 4-5 as high thrombus burden (HTB).
- RWPT was measured from the QRS complex onset to the R-wave peak in leads directed towards the infarct-related artery.
Main Results:
- Patients with HTB (n=105) exhibited significantly longer RWPT (53.58 ± 8.92 ms) compared to those with low thrombus burden (LTB, n=54; 47.96 ± 9.17 ms) (p < 0.01).
- Receiver operating characteristic analysis identified a preprocedural RWPT cutoff of > 46.5 ms for predicting HTB, demonstrating 87.62% sensitivity and 51.85% specificity (AUC 0.682, p < 0.001).
Conclusions:
- R wave peak time (RWPT) is a valuable, independent predictor of high thrombus burden in patients with STEMI.
- Utilizing RWPT may facilitate pre-angiographic risk stratification and inform treatment decisions in STEMI management.
Unassigned:
Background: Patients with higher thrombus burden have higher procedural complications and more long-term adverse cardiac events. Detecting patients with high thrombus burden (HTB) before coronary intervention could help avoid procedural complications. Objective: The research aimed to analyze the R wave peak time (RWPT) on the electrocardiogram to predict thrombus burden before coronary angiography in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: A total of 159 patients with STEMI were included in the study conducted at a tertiary medical center. The thrombolysis in myocardial infarction (TIMI) thrombus scale was applied to assess the thrombus burden. TIMI thrombus grades 0, 1, 2, and 3 were accepted as low; 4 and 5 had HTB. RWPT was measured from the beginning of the QRS complex to the R-peak from the leads pointing to the infarct-related artery. Results: Patients were divided into two groups according to their angiographically defined thrombus burden as low and high. The low thrombus burden group (LTB) comprised fifty-four patients, whereas the HTB group comprised 105 patients. In the LTB group, RWPT was 47.96 ± 9.17 ms, and in the HTB group was 53.58 ± 8.92 ms; it was significantly longer (p < 0.01). Receiver operating characteristic analysis showed that a cut-off value of preprocedural RWPT of > 46.5 ms predicted the occurrence of HTB with a sensitivity and specificity of 87.62% and 51.85%, respectively (AUC 0.682, 95% CI 0.590-0.774, p < 0.001). Conclusion: The present study evaluated the relationship between the RWPT and thrombus burden in STEMI patients. Based on the results, RWPT is an independent predictor of HTB.
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