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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 March;172(3):137-43
Wide QRS complex and myocardial tissue-level reperfusion in cardiogenic shock complicating ST-segment elevation myocardial infarction
Suzuki M. 1, Fujita S. 2, Seike F. 2, Enomoto D. 1, Honda K. 1
1 Section of Cardiology, Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan;
2 Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan
Aim: We addressed the crucial issue whether an initial 12-lead electrocardiogram (ECG) could predict the incident severely impaired myocardial tissue-level reperfusion possibly leading to adverse clinical outcome in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI).
Methods: ECG variables on admission were compared according to the presence or absence of severely impaired myocardial tissue-level reperfusion, which was defined by the presence of both Thrombolysis in Myocardial Infarction myocardial perfusion grade 0/1 and less than 30% resolution of the sum of ST-segment elevation after PCI, in a total of 38 consecutive patients with anterior STEMI complicated by cardiogenic shock.
Results: In-hospital mortality was markedly different between 22 patients with and 16 without severely impaired myocardial tissue-level reperfusion (77 vs. 25%, P=0.001). QRS duration (158±45 vs. 115±41 msec, P=0.005) and ST-segment elevation in lead aVR (0.12±0.10 vs. 0.05±0.11 mV, P=0.032) were greater in those with severely impaired myocardial tissue-level reperfusion. %resolution of sum of ST-segment elevation was inversely related to QRS duration (r=-0.421, P=0.008) and ST-segment elevation in lead aVR (r=-0.557, P=0.002). Multivariate analysis identified wide QRS duration as a potent predictor of severely impaired myocardial tissue-level reperfusion (odds ratio, 6.691; 95% confidence interval, 1.247 to 35.908).
Conclusion: Wide QRS duration in the initial ECG may alert subsequent severely impaired myocardial tissue-level reperfusion leading to fatal in-hospital outcome in patients with cardiogenic shock complicating anterior STEMI.