The role of baseline and post-procedural frontal plane QRS-T angles for cardiac risk assessment in patients with acute STEMI

Ann Noninvasive Electrocardiol. 2018 Sep;23(5):e12558. doi: 10.1111/anec.12558. Epub 2018 Jun 6.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: ST elevated myocardial infarction; baseline f(QRS-T) angle; post-procedural f(QRS-T) angle; risk assessment.

MeSH terms

  • Coronary Angiography / methods
  • Electrocardiography / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / methods*
  • Retrospective Studies
  • Risk Assessment
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / physiopathology*
  • ST Elevation Myocardial Infarction / therapy*
  • Thrombolytic Therapy / methods*