Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction

Abstract

BackgroundComplete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI.MethodsIn this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1–4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO).ResultsComplete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81.ConclusionsIn reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.

Estimating the extent of myocardial damage in patients with STEMI using the DETERMINE score

“…We could demonstrate a significant positive correlation between the DETERMINE score and IS. Furthermore, the DETERMINE score remained independently associated with IS even after adjustment for other parameters such as Selvester score, a complex ECG score that has been proposed previously for IS estimation, 9 as well as established clinical parameters such as hs-cTnT, hs-CRP, NT-proBNP, TIMI flow pre-interventional, and post-interventional PCI and anterior infarct localisation. Moreover, we observed a significant and independent association of the DETERMINE score with MVO, a severe marker of reperfusion injury with major prognostic implications in patients with STEMI.…”

“… 18 19 Especially the modified Selvester QRS score, a 37-criteria/29-points ECG scoring system, has been suggested for IS assessment. 9 20 However, it has recently been shown that the Selvester QRS score only has moderate association to CMR-determined IS. 9 Moreover, due to the numerous criteria that have to be fulfilled for the Selvester score, this score is hardly applicable in clinical practice.…”

“… 9 20 However, it has recently been shown that the Selvester QRS score only has moderate association to CMR-determined IS. 9 Moreover, due to the numerous criteria that have to be fulfilled for the Selvester score, this score is hardly applicable in clinical practice. Therefore, Lee et al introduced a simple ECG score based on the presence of abnormal ECG markers (combination of Q waves, fragmented QRS and inverted T waves) to estimate myocardial scar.…”

“…Measurements of high-sensitivity cardiac troponin T (hs-cTnT) were determined by using an enzyme immunoassay (hs-cTnT, E170; Roche Diagnostics, Vienna, Austria) according to the standard protocols of our working group as described previously. 9 For measurements of high-sensitivity C reactive protein (hs-CRP), the c702 module of cobas 8000 (Roche Diagnostics) was applied. 10 N-Terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured by a commercially available assay (E170 instrument proBNP II assay; Roche Diagnostics).…”

“… 14 MVO was defined as persisting area of ‘hypoenhancement’ within the infarction. 9 IS and MVO were expressed as percentages of LV myocardial mass (LVMM). Image analyses were performed by an established CMR core laboratory blinded to clinical and ECG data.…”