Colluoglu Tugce, Tanriverdi Zulkif, Unal Baris, Ozcan Emin Evren, Dursun Huseyin, Kaya Dayimi
Department of Cardiology, Karabuk Education and Research Hospital, Karabuk, Turkey.
Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
Ann Noninvasive Electrocardiol. 2018 Sep;23(5):e12558. doi: 10.1111/anec.12558. Epub 2018 Jun 6.
To our knowledge, no study so far investigated the importance of post-procedural frontal QRS-T angle f(QRS-T) in ST segment elevation myocardial infarction (STEMI). The aim of our study was to investigate the role of baseline and post-procedural f(QRS-T) angles for determining high risk STEMI patients, and the success of reperfusion.
A total of 248 patients with first acute STEMI that underwent primary percutaneous coronary intervention (pPCI) or thrombolytic therapy (TT) between 2013 and 2014 were included in this study. Baseline f(QRS-T) angle was defined as the angle which measured from the first ECG at the time of hospital admission. Post-procedural (QRS-T) angle was defined according to the treatment strategy as follows: the angle which measured from the post-PCI ECG in patients treated with pPCI; the angle which measured from the ECG taken 90 min after onset of therapy in patients treated with TT.
The baseline (101.9° ± 48.0 vs. 72.1° ± 49.1, p = 0.014) and post-procedural f(QRS-T) angles (95.7° ± 48.1 vs. 58.1° ± 47.1, p = 0.002) were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality. Also, f(QRS-T) angle measured at 90 min was significantly lower in patients with successful thrombolysis group compared to failed thrombolysis group (53.2° ± 42.8 vs. 77.3° ± 52.9, p = 0.033), whereas baseline f(QRS-T) angle was similar between two groups (78.6° ± 53.4 vs. 78.9° ± 54.0, p = 0.976). Multivariate analysis showed that post-procedural f(QRS-T) angle ≥89.6° (odds ratio: 3.541, 95% confidence interval: 1.235-10.154, p = 0.019), but not baseline f(QRS-T) angle, was independent predictor of in-hospital mortality.
f(QRS-T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post-procedural f(QRS-T) can predict in-hospital mortality and TT failure.
据我们所知，目前尚无研究调查过ST段抬高型心肌梗死（STEMI）患者术后额面QRS-T角（f(QRS-T)）的重要性。我们研究的目的是探讨基线和术后f(QRS-T)角在确定高危STEMI患者及再灌注成功率方面的作用。
本研究纳入了2013年至2014年间共248例首次发生急性STEMI并接受直接经皮冠状动脉介入治疗（pPCI）或溶栓治疗（TT）的患者。基线f(QRS-T)角定义为入院时首次心电图测量的角度。术后（QRS-T）角根据治疗策略定义如下：接受pPCI治疗的患者为PCI术后心电图测量的角度；接受TT治疗的患者为治疗开始90分钟后心电图测量的角度。
发生院内死亡的患者基线f(QRS-T)角（101.9°±48.0 vs. 72.1°±49.1，p = 0.014）和术后f(QRS-T)角（95.7°±48.1 vs. 58.1°±47.1，p = 0.002）显著高于未发生院内死亡的患者。此外，成功溶栓组患者90分钟时测量的f(QRS-T)角显著低于溶栓失败组（53.2°±42.8 vs. 77.3°±52.9，p = 0.033），而两组基线f(QRS-T)角相似（78.6°±53.4 vs. 78.9°±54.0，p = 0.976）。多因素分析显示，术后f(QRS-T)角≥89.6°（比值比：3.541，95%置信区间：1.235 - 10.154，p = 0.019）是院内死亡的独立预测因素，而基线f(QRS-T)角不是。
f(QRS-T)角可作为确定急性STEMI高危患者的有益工具。与以往研究不同，我们首次表明术后f(QRS-T)可预测院内死亡率和TT失败情况。
