Björn Redfors1, Ioanna Kosmidou2, Aaron Crowley1, Akiko Maehara3, Ori Ben-Yehuda3, Arslan Arif1, José M Dizon3, Gary S Mintz1, Gregg W Stone3. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States. 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States; Arrhythmia & Pacemaker Center, Department of Cardiology, St. Francis Hospital, Roslyn, NY, United States. Electronic address: ikosmidou@crf.org. 3. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States.
Abstract
BACKGROUND:QRS fragmentation (fQRS) is believed to reflect myocardial scar formation in patients with coronary disease. Whether early formation of fQRS in patients with ST-segment elevation myocardial infarction (STEMI) treated withpercutaneous coronary intervention (PCI) is correlated with infarct size and prognosis is unknown. We assessed the prognostic value of fQRS at 60min post-PCI and its correlation with infarct size in patients with anterior STEMI managed with primary PCI. METHODS: The INFUSE-AMI trial enrolled 452 patients with anterior STEMI undergoing primary PCI. Electrocardiograms (ECGs) were performed at baseline and 60min post-PCI. Infarct size was evaluated using cardiac magnetic resonance imaging at 30days post-PCI. Target vessel failure (TVF) was defined as the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization. Study groups were defined as patients with versus without fQRS at 60min post-PCI. RESULTS: Out of 421 patients with ECG data 60min post-PCI, 68 patients (16.2%) had fQRS. Patients with versus without fQRS had similar baseline characteristics and infarct size (16.9%±8.7% vs. 16.1%±10.5%, p=0.62), but patients with fQRS had higher adjusted risk of 1-year TVF (adjusted HR 2.27, 95% CI 1.06-4.89, p=0.036) and a trend toward a higher risk of the composite cardiac death or target vessel myocardial infarction (9.0% vs. 4.1%, p=0.08) at 1year. CONCLUSION:fQRS in patients with STEMI is associated with TVF but does not correlate with infarct size.
RCT Entities:
BACKGROUND: QRS fragmentation (fQRS) is believed to reflect myocardial scar formation in patients with coronary disease. Whether early formation of fQRS in patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) is correlated with infarct size and prognosis is unknown. We assessed the prognostic value of fQRS at 60min post-PCI and its correlation with infarct size in patients with anterior STEMI managed with primary PCI. METHODS: The INFUSE-AMI trial enrolled 452 patients with anterior STEMI undergoing primary PCI. Electrocardiograms (ECGs) were performed at baseline and 60min post-PCI. Infarct size was evaluated using cardiac magnetic resonance imaging at 30days post-PCI. Target vessel failure (TVF) was defined as the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization. Study groups were defined as patients with versus without fQRS at 60min post-PCI. RESULTS: Out of 421 patients with ECG data 60min post-PCI, 68 patients (16.2%) had fQRS. Patients with versus without fQRS had similar baseline characteristics and infarct size (16.9%±8.7% vs. 16.1%±10.5%, p=0.62), but patients with fQRS had higher adjusted risk of 1-year TVF (adjusted HR 2.27, 95% CI 1.06-4.89, p=0.036) and a trend toward a higher risk of the composite cardiac death or target vessel myocardial infarction (9.0% vs. 4.1%, p=0.08) at 1year. CONCLUSION: fQRS in patients with STEMI is associated with TVF but does not correlate with infarct size.
Authors: Teresa Strisciuglio; Giuseppe Ammirati; Valerio Pergola; Lucio Addeo; Maria Angela Losi; Aniello Viggiano; Livio Imparato; Vincenzo Russo; Enrico Melillo; Gerardo Nigro; Giuseppe Stabile; Antonio D'Onofrio; Giovanni Esposito; Antonio Rapacciuolo Journal: J Clin Med Date: 2021-04-23 Impact factor: 4.241
Authors: Daniel C Lee; Christine M Albert; Dhiraj Narula; Alan H Kadish; Gopi Krishna Panicker; Edwin Wu; Andi Schaechter; Julie Pester; Neal A Chatterjee; Nancy R Cook; Jeffrey J Goldberger Journal: J Am Heart Assoc Date: 2020-01-24 Impact factor: 5.501