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Early Q-wave morphology in prediction of reperfusion success in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention – A cardiac magnetic resonance imaging study

Topal, Divan Gabriel ; Lønborg, Jacob ; Ahtarovski, Kiril Aleksov ; Nepper-Christensen, Lars ; Fakhri, Yama ; Helqvist, Steffen ; Holmvang, Lene ; Høfsten, Dan ; Køber, Lars and Kelbæk, Henning , et al. (2020) In Journal of Electrocardiology 58. p.135-142
Abstract

Background: Pathological Q-wave (QW) in the electrocardiogram (ECG) before primary percutaneous coronary intervention (primary PCI) is a strong prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). However, current binary QW criteria are either not clinically applicable or have a lack of diagnostic performance. Accordingly, we evaluated the association between duration, depth and area of QW and markers of the effect of reperfusion (reperfusion success). Methods: A total of 516 patients with their first STEMI had obtained an ECG before primary PCI and an acute cardiac magnetic resonance imaging (CMR) at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 89–96). The largest measurable... (More)

Background: Pathological Q-wave (QW) in the electrocardiogram (ECG) before primary percutaneous coronary intervention (primary PCI) is a strong prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). However, current binary QW criteria are either not clinically applicable or have a lack of diagnostic performance. Accordingly, we evaluated the association between duration, depth and area of QW and markers of the effect of reperfusion (reperfusion success). Methods: A total of 516 patients with their first STEMI had obtained an ECG before primary PCI and an acute cardiac magnetic resonance imaging (CMR) at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 89–96). The largest measurable QW in ECG was used for analysis of duration, depth and area of QW (QW morphology). The QW morphology was evaluated as a continuous variable in linear regression models and as a variable divided in four equally large groups. Results: The QW morphology as four equally large groups was significantly associated with all CMR endpoints (p ≤ 0.001) and showed a linear relationship (p ≤ 0.001) with final infarct size (for QW duration, β = 0.47; QW depth, β = 0.41 and QW area, β = 0.39), final infarct transmurality (for QW duration, β = 0.36; QW depth, β = 0.26 and QW area, β = 0.23) and final myocardial salvage index (for QW duration, β = −0.34; QW depth, β = −0.26 and QW area, β = −0.24). Conclusion: Although modest, the QW morphology in STEMI patients showed significant linear association with markers of reperfusion success. Hence, it is suggested that the term pathological is not used as a dichotomous parameter in patients with STEMI but rather evaluated on the basis of extent.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Catheterization, Electrocardiogram, Magnetic resonance imaging, Myocardial infarction, Reperfusion
in
Journal of Electrocardiology
volume
58
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85076717129
  • pmid:31869764
ISSN
0022-0736
DOI
10.1016/j.jelectrocard.2019.12.011
language
English
LU publication?
no
id
737e179d-306f-4f5b-8c20-245a85a9a45f
date added to LUP
2020-01-03 10:46:18
date last changed
2021-06-08 03:56:21
@article{737e179d-306f-4f5b-8c20-245a85a9a45f,
  abstract     = {<p>Background: Pathological Q-wave (QW) in the electrocardiogram (ECG) before primary percutaneous coronary intervention (primary PCI) is a strong prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). However, current binary QW criteria are either not clinically applicable or have a lack of diagnostic performance. Accordingly, we evaluated the association between duration, depth and area of QW and markers of the effect of reperfusion (reperfusion success). Methods: A total of 516 patients with their first STEMI had obtained an ECG before primary PCI and an acute cardiac magnetic resonance imaging (CMR) at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 89–96). The largest measurable QW in ECG was used for analysis of duration, depth and area of QW (QW morphology). The QW morphology was evaluated as a continuous variable in linear regression models and as a variable divided in four equally large groups. Results: The QW morphology as four equally large groups was significantly associated with all CMR endpoints (p ≤ 0.001) and showed a linear relationship (p ≤ 0.001) with final infarct size (for QW duration, β = 0.47; QW depth, β = 0.41 and QW area, β = 0.39), final infarct transmurality (for QW duration, β = 0.36; QW depth, β = 0.26 and QW area, β = 0.23) and final myocardial salvage index (for QW duration, β = −0.34; QW depth, β = −0.26 and QW area, β = −0.24). Conclusion: Although modest, the QW morphology in STEMI patients showed significant linear association with markers of reperfusion success. Hence, it is suggested that the term pathological is not used as a dichotomous parameter in patients with STEMI but rather evaluated on the basis of extent.</p>},
  author       = {Topal, Divan Gabriel and Lønborg, Jacob and Ahtarovski, Kiril Aleksov and Nepper-Christensen, Lars and Fakhri, Yama and Helqvist, Steffen and Holmvang, Lene and Høfsten, Dan and Køber, Lars and Kelbæk, Henning and Vejlstrup, Niels and Engstrøm, Thomas},
  issn         = {0022-0736},
  language     = {eng},
  pages        = {135--142},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Early Q-wave morphology in prediction of reperfusion success in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention – A cardiac magnetic resonance imaging study},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2019.12.011},
  doi          = {10.1016/j.jelectrocard.2019.12.011},
  volume       = {58},
  year         = {2020},
}