Predictive Value of Terminal QRS Distortion in Anterior Wall Acute Myocardial Infarction

Abstract

Background. The initial ECG at patients with Acute Coronary Syndrome, especially STEMI can predict size of infarction, response to reperfusion therapy and long term prognosis. A new classification, the QRS distortion have increased mortality rates and larger infarct size and less limitation of their infarct size by thrombolytic therapy. QRS distortion is the emergence of J point = 50% of R wave in leads with qR configuration (I, aVL, V4-V6), or disappearance of the S wave in leads with Rs configuration (V1-V3).
Methods and results.This study is cohort-retrospective to patients with anterior IMA treated by thrombolytic at National Cardiovascular Centre – Harapan Kita, Jakarta, Indonesia, during January 2003 – September 2004, that fulfill inclusion and exclusion criterias. They were divided into two group, with QRS distortion (+) and without QRS distortion (-); each group consist of 30 patients. Correlation between the two groups were ana-lyzed by t test, chi-square test, Mann Whitney u test and logistic regres-sion. Patients age range is 40 – 69 years, and mostly man. There is no difference between baseline characteristic in the two groups, except cho-lesterol LDL which is higher in the group with QRS distortion. Patients with QRS distortion have a higher tendency of thrombolytic therapy fail-ure compare to patients without QRS distortion, (p=0,003). As the con-sequence they also have a higher rate of arrhythmia events, low ejection fraction and re-hospitalization due to congestive heart failure.
Conclusions. The prognosis of patients with anterior IMA associated with QRS distortion is worse than without QRS distortion.

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References

PERKI. Pedoman Tatalaksana Penyakit Kardiovaskuler di Indonesia 2003.

Birnbaum Y, Sclarovsky S, Blum A, et al. Prognostic Significance of the Initial Electrocardiographic Pattern in a First Acute Anterior Wall Myocardial Infarction. Chest 1993; 103: 1681-87.

Birnbaum Y, Maynard C, Wolfe S, et al. Terminal QRS Distortion on Admission Is Better Than ST-Segment Measurements in Predicting Final Infarct Size and Assessing the Potential Effect of Thrombolytic Therapy in Anterior Wall Acute Myocardial Infarction. Am J cardiol 1999; 84: 530-534.

Birnbaum Y, Kloner RA, Sclarovsky S, et al. Distortion of the Terminal Portion of the QRS on the Admission Electrocardiogram in Acute Myocardial Infarction and Correlation With Infarct size and Long-Term Prognosis (Thrombolysis in Myocardial Infarction 4 Trial). Am J Cardiol 1996; 78: 396-403.

Birnbaum Y, Herz I, Sclarovsky S, et al. Admission clinical and electrocardiographic characteristics predicting an increased risk for early reinfarction after thrombolytic therapy. Am Heart J 1998; 135: 805-12.

Sucu MM, Karadede A, Aydinalp O, et al. The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamin Stress Echocardiography in Acute Anterior Myocardial Infarction. Jpn Heart J 2004; 45: 373-386.

Estes NAM, Salem DN. Predictive value of the Electrocardiogram in Acute Coronary Syndromes. JAMA 1999; 281: 753-754.

Lee PY, Chen WH. Reperfusion Therapy for ST-Elevation Myocardial Infarction. Med Progress 2002; 31-37.

Billgren T, Maynard C, Christian TF et al. Grade 3 ischaemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty. J electrocardiol 2005;38:187-194.

Birnbaum Y, Criger DA, Wagner GS, et al. Prediction of the extent and severity of the left ventricular dysfunction in anterior acute myocardial infarction by the admission electrocardiogram. Am Heart J 2001; 141: 915-24.

Purcell IF, Newall N, Farrer M. Change in ST segmen elevation 60 minute after thrombolytic initiation predicts clinical outcome as accurately as later electrocardiographic changes. Heart 1997;78:465-471.

ECC guidelines. Part 7: The Era of Reperfusion. Circulation 2000;102:1-62.

Christian TF, Gibbons RJ, Clements IP, et al. Estimates of Myocardium at Risk and Collateral Flow in Acute Myocardial Infarction Using Electrocardiographic Indexes With Comparison to Radionuclide and Angiographic Measures. J Am Coll Cardiol 1995;26:388-93

Birnbaum Y, Sclarovsky S. The Grade of Ischemia on the Presenting Electrocardiogram of Patients With ST Elevation Acute Myocardial Infarction. J Electrocardiol 2001; 34: 17-26.
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How to Cite
Predictive Value of Terminal QRS Distortion in Anterior Wall Acute Myocardial Infarction. (1). Indonesian Journal of Cardiology, 28(3), 203-210. https://doi.org/10.30701/ijc.v28i3.242
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Clinical Research