Electrocardiogram to predict reperfusion success in late presenters with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

• Published in: Journal of electrocardiology Vol. 59; pp. 74 - 80
• Main Authors: Topal, Divan Gabriel, Nepper-Christensen, Lars, Lønborg, Jacob, Ahtarovski, Kiril Aleksov, Tilsted, Hans-Henrik, Sørensen, Rikke, Pedersen, Frants, Joshi, Francis, Bang, Lia E., Fakhri, Yama, Helqvist, Steffen, Holmvang, Lene, Høfsten, Dan, Køber, Lars, Kelbæk, Henning, Vejlstrup, Niels, Engstrøm, Thomas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020; Elsevier Science Ltd
• Subjects: Angioplasty; Electrocardiogram; Electrocardiography; Heart attacks; Magnetic resonance imaging; Percutaneous coronary intervention; ST-segment elevation myocardial infarction; Percutaneous coronary intervention; ST-segment elevation myocardial infarction; Magnetic resonance imaging; Electrocardiogram
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2020.01.008

Clinical decision-making in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 h of symptom onset (late presenters) is challenging. However, the electrocardiogram (ECG) may provide helpful information. We investigated the association between three ECG-scores and myocardial salvage and infarct size in late presenters treated with primary percutaneous coronary intervention (primary PCI). Sixty-six patients with STEMI and ongoing symptoms presenting 12–72 h after symptom onset were included. Cardiac magnetic resonance was performed at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 93 (IQR, 90–98). The pre-PCI ECG was analyzed for the presence of pathological QW (early QW) as well as Anderson-Wilkins acuteness score (AW-score), the classic Sclarovsky-Birnbaum Ischemia Grading System (classic SB-IG-score) and a modified SB-IG-score including any T-wave morphologies. Early QW was associated with a larger myocardium at risk (39 ± 12 versus 33 ± 12; p = 0.030) and final infarct size (20 ± 11 versus 14 ± 9; p = 0.021) as well as a numerical lower final myocardial salvage (0.52 ± 0.19 versus 0.61 ± 0.23; p = 0.09). The association with final infarct size disappeared after adjusting for myocardium at risk. An AW-score < 3 showed a trend towards a larger final infarct size (18 ± 11 versus 11 ± 11; p = 0.08) and was not associated with salvage index (0.55 ± 0.20 versus 0.65 ± 0.30; p = 0.23). The classic and modified SB-IG-score were not associated with final infarct size (modified SB-IG-score, 17 ± 10 versus 21 ± 13; p = 0.28) or final myocardial salvage (0.53 ± 0.20 versus 0.53 ± 0.26; p = 0.96). Of three well-established ECG-scores only early QW and AW-score < 3 showed association with myocardium at risk and infarct size to some extent, but the association with myocardial salvage was weak. Hence, neither of the three investigated ECG-scores are sufficient to guide clinical decision-making in patients with STEMI and ongoing symptoms presenting beyond 12 h of symptom onset.