Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
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Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. / Topal, Divan Gabriel; Nepper-Christensen, Lars; Lønborg, Jacob; Ahtarovski, Kiril Aleksov; Tilsted, Hans Henrik; Sørensen, Rikke; Pedersen, Frants; Joshi, Francis; Bang, Lia E.; Fakhri, Yama; Helqvist, Steffen; Holmvang, Lene; Høfsten, Dan; Køber, Lars; Kelbæk, Henning; Vejlstrup, Niels; Engstrøm, Thomas.
I: Journal of Electrocardiology, Bind 59, 2020, s. 74-80.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
AU - Topal, Divan Gabriel
AU - Nepper-Christensen, Lars
AU - Lønborg, Jacob
AU - Ahtarovski, Kiril Aleksov
AU - Tilsted, Hans Henrik
AU - Sørensen, Rikke
AU - Pedersen, Frants
AU - Joshi, Francis
AU - Bang, Lia E.
AU - Fakhri, Yama
AU - Helqvist, Steffen
AU - Holmvang, Lene
AU - Høfsten, Dan
AU - Køber, Lars
AU - Kelbæk, Henning
AU - Vejlstrup, Niels
AU - Engstrøm, Thomas
PY - 2020
Y1 - 2020
N2 - Background: Clinical decision-making in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 h of symptom onset (late presenters) is challenging. However, the electrocardiogram (ECG) may provide helpful information. We investigated the association between three ECG-scores and myocardial salvage and infarct size in late presenters treated with primary percutaneous coronary intervention (primary PCI). Methods: Sixty-six patients with STEMI and ongoing symptoms presenting 12–72 h after symptom onset were included. Cardiac magnetic resonance was performed at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 93 (IQR, 90–98). The pre-PCI ECG was analyzed for the presence of pathological QW (early QW) as well as Anderson-Wilkins acuteness score (AW-score), the classic Sclarovsky-Birnbaum Ischemia Grading System (classic SB-IG-score) and a modified SB-IG-score including any T-wave morphologies. Results: Early QW was associated with a larger myocardium at risk (39 ± 12 versus 33 ± 12; p = 0.030) and final infarct size (20 ± 11 versus 14 ± 9; p = 0.021) as well as a numerical lower final myocardial salvage (0.52 ± 0.19 versus 0.61 ± 0.23; p = 0.09). The association with final infarct size disappeared after adjusting for myocardium at risk. An AW-score < 3 showed a trend towards a larger final infarct size (18 ± 11 versus 11 ± 11; p = 0.08) and was not associated with salvage index (0.55 ± 0.20 versus 0.65 ± 0.30; p = 0.23). The classic and modified SB-IG-score were not associated with final infarct size (modified SB-IG-score, 17 ± 10 versus 21 ± 13; p = 0.28) or final myocardial salvage (0.53 ± 0.20 versus 0.53 ± 0.26; p = 0.96). Conclusion: Of three well-established ECG-scores only early QW and AW-score < 3 showed association with myocardium at risk and infarct size to some extent, but the association with myocardial salvage was weak. Hence, neither of the three investigated ECG-scores are sufficient to guide clinical decision-making in patients with STEMI and ongoing symptoms presenting beyond 12 h of symptom onset.
AB - Background: Clinical decision-making in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 h of symptom onset (late presenters) is challenging. However, the electrocardiogram (ECG) may provide helpful information. We investigated the association between three ECG-scores and myocardial salvage and infarct size in late presenters treated with primary percutaneous coronary intervention (primary PCI). Methods: Sixty-six patients with STEMI and ongoing symptoms presenting 12–72 h after symptom onset were included. Cardiac magnetic resonance was performed at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 93 (IQR, 90–98). The pre-PCI ECG was analyzed for the presence of pathological QW (early QW) as well as Anderson-Wilkins acuteness score (AW-score), the classic Sclarovsky-Birnbaum Ischemia Grading System (classic SB-IG-score) and a modified SB-IG-score including any T-wave morphologies. Results: Early QW was associated with a larger myocardium at risk (39 ± 12 versus 33 ± 12; p = 0.030) and final infarct size (20 ± 11 versus 14 ± 9; p = 0.021) as well as a numerical lower final myocardial salvage (0.52 ± 0.19 versus 0.61 ± 0.23; p = 0.09). The association with final infarct size disappeared after adjusting for myocardium at risk. An AW-score < 3 showed a trend towards a larger final infarct size (18 ± 11 versus 11 ± 11; p = 0.08) and was not associated with salvage index (0.55 ± 0.20 versus 0.65 ± 0.30; p = 0.23). The classic and modified SB-IG-score were not associated with final infarct size (modified SB-IG-score, 17 ± 10 versus 21 ± 13; p = 0.28) or final myocardial salvage (0.53 ± 0.20 versus 0.53 ± 0.26; p = 0.96). Conclusion: Of three well-established ECG-scores only early QW and AW-score < 3 showed association with myocardium at risk and infarct size to some extent, but the association with myocardial salvage was weak. Hence, neither of the three investigated ECG-scores are sufficient to guide clinical decision-making in patients with STEMI and ongoing symptoms presenting beyond 12 h of symptom onset.
KW - Electrocardiogram
KW - Magnetic resonance imaging
KW - Percutaneous coronary intervention
KW - ST-segment elevation myocardial infarction
U2 - 10.1016/j.jelectrocard.2020.01.008
DO - 10.1016/j.jelectrocard.2020.01.008
M3 - Journal article
C2 - 32007909
AN - SCOPUS:85078664062
VL - 59
SP - 74
EP - 80
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
SN - 0022-0736
ER -
ID: 260599084