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

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 percutaneo...

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Autores principales:	Tomasz Fabiszak, Michał Kasprzak, Marek Koziński, Jacek Kubica
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	myocardial infarction ECG risk stratification left ventricular systolic dysfunction primary PCI Medicine R
Acceso en línea:	https://doaj.org/article/d9152314338c47968c2963cdbf896758
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spelling	oai:doaj.org-article:d9152314338c47968c2963cdbf8967582021-11-25T18:02:53ZAssessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction10.3390/jcm102254452077-0383https://doaj.org/article/d9152314338c47968c2963cdbf8967582021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5445https://doaj.org/toc/2077-0383Objective: 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 (<i>n</i> = 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; <i>p</i> < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; <i>p</i> < 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; <i>p</i> = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R<sup>2</sup> 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 R<sup>2</sup> = 0.448; <i>p</i> < 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.Tomasz FabiszakMichał KasprzakMarek KozińskiJacek KubicaMDPI AGarticlemyocardial infarctionECGrisk stratificationleft ventricular systolic dysfunctionprimary PCIMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5445, p 5445 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	myocardial infarction ECG risk stratification left ventricular systolic dysfunction primary PCI Medicine R
spellingShingle	myocardial infarction ECG risk stratification left ventricular systolic dysfunction primary PCI Medicine R Tomasz Fabiszak Michał Kasprzak Marek Koziński Jacek Kubica Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
description	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 (<i>n</i> = 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; <i>p</i> < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; <i>p</i> < 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; <i>p</i> = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R<sup>2</sup> 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 R<sup>2</sup> = 0.448; <i>p</i> < 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.
format	article
author	Tomasz Fabiszak Michał Kasprzak Marek Koziński Jacek Kubica
author_facet	Tomasz Fabiszak Michał Kasprzak Marek Koziński Jacek Kubica
author_sort	Tomasz Fabiszak
title	Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
title_short	Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
title_full	Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
title_fullStr	Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
title_full_unstemmed	Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction
title_sort	assessment of selected baseline and post-pci electrocardiographic parameters as predictors of left ventricular systolic dysfunction after a first st-segment elevation myocardial infarction
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d9152314338c47968c2963cdbf896758
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Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

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