Abstract 17205: The Value of QS-Pattern in Leads V1 to V3 for Predicting Improvement of Left Ventricular Function After ST-elevation Myocardial Infarction
Background: Previous studies have reported value of the electrocardiogram (ECG) at admission in predicting infarct size and prognosis after ST-elevation myocardial infarction (STEMI). Despite admitting to the hospital immediately after onset of chest symptoms, some patients’ ECG revealed QS-pattern in anterior chest leads after STEMI. We investigated the impact of QS-pattern on the initial ECG on recovery of left ventricular function in anterior STEMI patients.
Method: We examined 127 consecutive first anterior STEMI patients with normal preprocedural CK-MB levels who admitted within 6 h from onset of symptoms. All patients underwent primary percutaneous coronary intervention (PCI) for the left anterior descending artery (LAD) lesions immediately after admission. The patients were divided into two groups according to the presence of QS-pattern in V1 to V3 on preprocedural ECG (QS-pattern group: n=30, non-QS-pattern group: n=97). An echocardiogram was obtained within 24 h of presentation and at 3 months after the acute event. A wall motion score (WMS) was calculated using a 16-segment model. Thrombolysis in myocardial infarction (TIMI) grade score at the end of initial procedure was also recorded.
Result: There were no differences in preprocedural troponin level and time interval from onset to revascularization between two groups. However, the incidence of TIMI grade <3 on final angiogram and peak CK-MB level were significantly higher in the QS-pattern than in the non-QS-pattern groups (70% vs. 21%, P<0,0001, and 473±256 IU/L vs. 249±188 IU/L, P<0.001, respectively). Moreover, the WMS at 3-month follow-up was significantly worse in the QS-pattern group compared with the non-QS-pattern group (30±4.2 vs. 24±6.2, P<0.01), although the baseline WMS was comparable in the two groups.
Conclusions: Among patients reached to the hospital soon after the onset of infarction, ECGs revealed QS-pattern in lead V1 to V3 in approximately 20% of patients with first anterior STEMI. These patients showed a greater rise of biomarkers of myocardial necrosis and poor recovery of left ventricular function. This easily assessable ECG pattern is useful in clinical risk stratification for anterior STEMI patients.
Author Disclosures: T. Horimatsu: None. K. Fujii: None. M. Fukunaga: None. T. Imanaka: None. K. Miki: None. H. Tamaru: None. A. Sumiyoshi: None. T. Saita: None. M. Nishimura: None. M. Takada: None. Y. Nishibori: None. T. Maruyama: None. T. Masuyama: None.
- © 2014 by American Heart Association, Inc.