Simplified Selvester QRS Score as an Infarct Size Parameter in STEMI Patients Undergoing Pharmacoinvasive or Primary Percutaneous Coronary Intervention
Abstract
Background:Cardiovascular disease especially acute myocardial infarct (AMI) is one of the highest cause of mortality worldwide. Majority of AMI comes in the form of ST elevation myocardial infarct (STEMI) that requires timely diagnosis and revascularization management to restore myocardial circulation. The simple method to estimate infarct size is by using simplified Selvester QRS Score to electrocardiogram records, which is a tested method that have good correlation with gold standard, namely cardiac magnetic resonance imaging.
Objectives : To investigate difference of infarct size with simplified Selvester QRS score parameter between STEMI patients undergoing pharmacoinvasive compared to primary PCI.
Methods: Eighty-two STEMI patients, 41 of pharmacoinvasive and 41 of primary PCI was scored with simplified Selvester QRS score from electrocardiogram recording. Patient data are retroactively taken form Sardjito Cardiovascular Intensive Care (SCIENCE) registry. Scoring of simplified Selvester QRS Score was done by two experienced cardiologist blinded to patient procedure, and results then measured for interobserver agreement with Bland-Altman test. Comparison of QRS Score in pharmacoinvasive and primary PCI group was done with independent sample T test followed with multivariable linear regression test.
Results: The means of simplified Selvester QRS score in pharmacoinvasive and primary PCI group is 7.240±3.015 and 8.900±4.188, p=0.043, respectively. Independent sample T test shows significant difference in the simplified Selvester QRS score in pharmacoinvasive and primary PCI group. The multivariable analysis shows that variables other than revascularization method independently influences QRS score are onset, anterior segment ST elevation and ST segment elevation in more > 3 leads in electrocardiogram.
Conclusion: There is significant difference in infarct size measured by simplified Selvester QRS score betweem STEMI patient undergoing pharmacoinvasive method compared to primary PCI procedure, which is lower in the pharmacoinvasive group
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2. Nijveldt R, van der Vleuten PA, Hirsch A, Beek AM, Tio RA, Tijssen JG, Piek JJ, van Rossum AC, Zijlstra F. Early electrocardiographic findings and MR imaging-verified microvascular injury and myocardial infarct size. JACC Cardiovasc Imaging. 2009;2(10):1187-94..
3. Arso IA, Setianto BY, Taufiq N, Hartopo AB. In-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI. Acta Med Indones. 2014;46(2):124-30.
4. Antman, E.M., and Braunwald E., 2008. ST Elevation Myocardial Infarction: Pathology, Pathophysiology and Clinical Feature. Braunwald’s Heart Disease: A Textbook of Cardiovascular. McGraw-Hill. New York. U.S.A.
5. Selvester RH, Wagner GS, Hindman NB. The Selvester QRS scoring system for estimating myocardial infarct size. The development and application of the system. Arch Intern Med. 1985;145(10):1877-81..
6. Shiomi H, Kosuge M, Morimoto T, Watanabe H, Taniguchi T, Nakatsuma K, Toyota T, Yamamoto E, Shizuta S, Tada T, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Kimura K, Kimura T; CREDO-Kyoto AMI Investigators. QRS Score at Presentation Electrocardiogram Is Correlated With Infarct Size and Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Circ J. 2017 Jul 25;81(8):1129-1136.
7. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177..
8. Abreu D, Salomé Cabral M, Ribeiro F. Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction. Int J Cardiol Heart Vessel. 2014 Jul 10;4:97-101..
9. Bainey KR, Armstrong PW, Zheng Y, Brass N, Tyrrell BD, Leung R, Westerhout CM, Welsh RC. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction in Clinical Practice: Insights From the Vital Heart Response Registry. Circ Cardiovasc Interv. 2019 Oct;12(10):e008059.
10. Bang LE, Ripa RS, Grande P, Kastrup J, Clemmensen PM, Wagner GS. Comparison of infarct size changes with delayed contrast-enhanced magnetic resonance imaging and electrocardiogram QRS scoring during the 6 months after acutely reperfused myocardial infarction. J Electrocardiol. 2008 Nov-Dec;41(6):609-13.
11. Carlsen EA, Bang LE, Ahtarovski KA, Engstrøm T, Køber L, Kelbæk H, Vejlstrup N, Jørgensen E, Helqvist S, Saunamäki K, Clemmensen P, Holmvang L, Wagner GS, Lønborg J. Comparison of Selvester QRS score with magnetic resonance imaging measured infarct size in patients with ST elevation myocardial infarction. J Electrocardiol. 2012 Jul-Aug;45(4):414-419..
12. Nugraha IW, Hartopo AB, Taufiq N. wire crossing time correlates with left ventricular end-diastolic pressure in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indonesian J Cardiol 2020;41:143-152.
13. Knippenberg SA, Wagner GS, Ubachs JF, Gorgels A, Hedström E, Arheden H, Engblom H. Consideration of the impact of reperfusion therapy on the quantitative relationship between the Selvester QRS score and infarct size by cardiac MRI. Ann Noninvasive Electrocardiol. 2010 Jul;15(3):238-44.
14. Engblom H, Hedström E, Heiberg E, Wagner GS, Pahlm O, Arheden H. Size and transmural extent of first-time reperfused myocardial infarction assessed by cardiac magnetic resonance can be estimated by 12-lead electrocardiogram. Am Heart J. 2005 Nov;150(5):920.
15. Lee DC, Albert CM, Narula D, Kadish AH, Panicker GK, Wu E, Schaechter A, Pester J, Chatterjee NA, Cook NR, Goldberger JJ. Estimating Myocardial Infarction Size With a Simple Electrocardiographic Marker Score. J Am Heart Assoc. 2020 Feb 4;9(3):e014205.
16. Birnbaum Y, Strasberg B. The predischarge electrocardiographic pattern in anterior acute myocardial infarction: relation between evolutionary ST segment and T-wave configuration and prediction of myocardial infarct size and left ventricular systolic function by the QRS Selvester score. J Electrocardiol. 2000;33 Suppl:73-80..
17. Rovers WC, van Boreen MC, Robinson M, Martin TN, Maynard C, Wagner GS, Gorgels AP. Comparison of the correlation of the Selvester QRS scoring system with cardiac contrast-enhanced magnetic resonance imaging-measured acute myocardial infarct size in patients with and without thrombolytic therapy. J Electrocardiol. 2009 Mar-Apr;42(2):139-44.
18. Geerse DA, Wu KC, Gorgels AP, Zimmet J, Wagner GS, Miller JM. Comparison between contrast-enhanced magnetic resonance imaging and Selvester QRS scoring system in estimating changes in infarct size between the acute and chronic phases of myocardial infarction. Ann Noninvasive Electrocardiol. 2009 Oct;14(4):360-5..
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