Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

Abstract

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04–0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.

Frequency of Failure of St-Segment Resolution after Primary Percutaneous Coronary Intervention in Patients with St-Segment Elevation Acute Myocardial Infarction

“…Higher peak creatine kinase levels and a higher incidence of severe LVSD were also found when complete ST-segment resolution was not achieved. 19,22 As per previous published study, 86 percent of cases had TIMI flow grade III recovery after pPCI, and that low systolic BP, old age and the occurrence of blood clots in the culprit coronary lesions were independent predictive factors for TIMI flow grade III recovery. 23 STR has been shown to be a stronger predictive marker than epicardial blood flow recovery.…”

“…In compared to partial (30-70%) or no (30%) STsegment resolution, complete (70%) resolution predicts lower 1-3year mortality and lower incidence of cardiovascular potential complications, as well as greater maintenance of left ventricular function. 19,20 Even after successful primary PCI, the benefits of early complete resolution of ST-segment elevation can be demonstrated, with early (i.e., immediately after PCI) testing being more accurate in terms of predicting CVD adverse events than evaluation after 90 minutes. 19,21 Furthermore, patients who had early ST-segment resolution had a larger LVEF than those who had ST-segment resolution after 90 minutes.…”

“…19,20 Even after successful primary PCI, the benefits of early complete resolution of ST-segment elevation can be demonstrated, with early (i.e., immediately after PCI) testing being more accurate in terms of predicting CVD adverse events than evaluation after 90 minutes. 19,21 Furthermore, patients who had early ST-segment resolution had a larger LVEF than those who had ST-segment resolution after 90 minutes. Higher peak creatine kinase levels and a higher incidence of severe LVSD were also found when complete ST-segment resolution was not achieved.…”

Putative Prevention of XML Injection Against Myocardial Ischemia Is Mediated by PKC and PLA2 Proteins

“…In our study, six groups of SD rats were generated: CON (saline pretreatment for 4 days followed by normal saline injection, n = 5), ISO (saline pretreatment for 4 days followed by isoproterenol injection, n = 5), IX-L (31.25 mg/kg XML pretreatment for 4 days followed by isoproterenol injection, n = 5), IX-M (62.5 mg/kg XML pretreatment for 4 days followed by isoproterenol injection, n = 6), IX-H (125 mg/kg XML pretreatment for 4 days followed by isoproterenol injection, n = 5), and IP (propranolol pretreatment for 4 days followed by isoproterenol injection, n = 5) ( Figure 1A ). Electrocardiograph (ECG) is the most common test used in the clinic to assess suspected or known cases of myocardial ischemia ( Fabiszak et al, 2021 ). Changes in the ST segment and T-wave should be observed if myocardial ischemia has occurred ( Thygesen et al, 2018 ).…”

Effect of COVID-19 pandemic on six-month mortality and clinical outcomes of patients with ST-elevation myocardial infarction

“…Our study found STR to be an independent and significant predictor of mortality after 6 months ( p < 0.001). In a previous study that aimed to use baseline electrocardiographic parameters as predictors of impaired LV systolic function in patients who underwent PCI due to first-time STEMI, the authors noted that patients with complete (≥ 70%) resolution of ST-segment elevation had lower 1–3-year mortality and lower rates of cardiovascular adverse events, and had better preservation of left ventricular function in comparison with partial (30–70%) or no (< 30%) ST-segment resolution [ 31 ].…”