Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction.

Alberto Cipriani,Gianpiero D’Amico,Luisa Cacciavillani,Domenico Corrado,Marco Gambato,Alessandro Zorzi,Nicolò Martini,Martina Previato,Giovanni Maria Vescovo,Francesco Cardaioli,Giulia Brunetti,Pietro Bernardo Dall’Aglio,Sabino Iliceto,Filippo Donato,Martina Perazzolo Marra

doi:10.3390/jcm10245933

Alberto Cipriani, Gianpiero D’Amico + Show 13 more

Open Access

https://doi.org/10.3390/jcm10245933

Copy DOI

Abstract

Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI.

Highlights

We described the “triangular QRS-ST-T waveform” (TW), a distinctive ST-elevation myocardial infarction (STEMI) pattern characterized by a single, giant, triangular wave, resulting from the fusion of the QRS complex, the ST-segment, and the T-wave, and we observed that patients presenting with the TW
We investigated the predictive value of specific electrocardiographic STEMI patterns—the tombstone, Lambda, and TW (Figure 1)—for the occurrence of Primary ventricular fibrillation (PVF) during the early phase of STEMI and for 30-day mortality
The main results of the study were: (1) ECG detection of a Lambda or TW STEMI pattern was a strong and independent predictor of PVF before primary percutaneous coronary intervention (PCI); (2) significant predictors of 30-day mortality were the occurrence of PVF, and lower left ventricular ejection fraction (LVEF); and (3) the effect of Lambda or TW

Summary

Introduction

Primary ventricular fibrillation (PVF) occurs commonly during the early phase of ST-elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (PCI), and has been associated with an increased short- [1] and long-term risk of death [2,3]. Several risk factors for PVF are known including clinical, hemodynamic, and electrocardiographic parameters, and their recognition is useful to optimize the early management of STEMI patients [4,5,6]. We described the “triangular QRS-ST-T waveform” (TW), a distinctive STEMI pattern characterized by a single, giant, triangular wave, resulting from the fusion of the QRS complex, the ST-segment, and the T-wave, and we observed that patients presenting with the TW pattern more frequently had PVF, cardiogenic shock, and higher in-hospital mortality [10]

Objectives

Methods

Results

Conclusion