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.

Highlights

  • Electrocardiography (ECG), invented by Willem Einthoven nearly 120 years ago, remains one of the essential diagnostic modalities in cardiology [1], shaping the elementary division of acute coronary syndromes into those with and without persistent ST-segment depression, affecting the timing and mode of management and adding to short- and long-term risk stratification [2,3,4].It is estimated that left ventricular systolic dysfunction (LVSD), recognized as a longterm consequence of myocardial infarction (MI), may affect up to 60% of post-MI patients [5]

  • Patients who presented with LVSD after 6 months of follow-up showed a higher prevalence of diabetes mellitus, left anterior descending artery (LAD) as the infarct-related artery (IRA) and TIMI 0 flow before

  • We found that thoroughly anterior location of segment-elevation myocardial infarction (STEMI), longer post-percutaneous coronary intervention (PCI)

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Summary

Introduction

It is estimated that left ventricular systolic dysfunction (LVSD), recognized as a longterm consequence of myocardial infarction (MI), may affect up to 60% of post-MI patients [5]. LVSD is a well-recognized marker of unfavorable prognosis in post-MI patients [8], translating into a 3–4-fold increase in mortality and higher rates of cardiovascular adverse outcomes, such as cardiac rupture, sudden cardiac arrest, recurrent myocardial infarction, ventricular arrhythmias, stroke, prolonged hospitalization and rehospitalization [7,9,10,11]. The mortality rate among post-MI patients with asymptomatic LVSD after 12 months of MI is as high as 12% and amounts to 36% in symptomatic patients [12]. LVSD independently predicts short-, mid- and long-term mortality after MI [12,13,14,15]

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