TY - JOUR
TI - QT-interval dispersion in acute myocardial infarction is only shortened
by thrombolysis in myocardial infarction grade 2/3 reperfusion
AU - Nikiforos, S
AU - Hatzisavvas, J
AU - Pavlides, G
AU - Voudris, V and
AU - Vassilikos, VP
AU - Manginas, A
AU - Hatzeioakim, G
AU - Foussas, S and
AU - Iliodromitis, EK
AU - Hatseras, D
AU - Kremastinos, DT
AU - Cokkinos, DV
JO - Clinical Cardiology
PY - 2003
VL - 26
TODO - 6
SP - 291-295
PB - Wiley
SN - 0160-9289, 1932-8738
TODO - 10.1002/clc.4950260611
TODO - thrombolysis; primary percutaneous transluminal coronary angioplasty;
acute myocardial infarction; QT dispersion
TODO - Background: Increased QT interval dispersion (QTd) has been found in
patients with acute myocardial infarction (AMI). In previous studies
this has been shown to decrease with thrombolysis.
Hypothesis: The aim of this study was to compare the effects of
reperfusion by primary percutaneous transluminal coronary angioplasty
(PTCA) and by thrombolysis on QTd and correlate these results with the
degree of reperfusion.
Methods: We studied 60 patients with a first AMI The study cohort
included 40 consecutive patients who had received thrombolysis
(streptokinase or rt-PA); 20 additional consecutive patients with
successful primary PTCA, all with preselected Thrombolysis in Myocardial
Infarction (TIMI) grade 3 flow by predefined selection criteria (12
stents); and 20 controls. A 12-lead ECG for QTd calculation was recorded
before thrombolysis or PTCA and immediately after the procedure. All
values were corrected according to Bazett’s formula (QTcd). QTd and QTcd
values before and after each procedure in three groups and the
respective percent changes of DeltaQTd and DeltaQTcd were compared
separately.
Results: QTd and QTcd were significantly increased before
thrombolysis/PTCA versus normals. An angiogram performed after
thrombolysis showed adequate reperfusion (TIMI grade 2/3) in 20
patients, while in the other 20 only TIMI 0/1 reperfusion was achieved.
Thrombolysis-TIMI flow 2/3 and PTCA significantly reduced QTd (from 68
+/- 10 to 35 +/- 8 ms, p< 0.001, DeltaQTd = 48 +/- 11%, in the Thr-TIMI
flow 2/3 group, and from 79 +/- 11% to 38 +/- 9 ms, p<0.001, DeltaQTd =
52 +/- 9%, in the PTCA group), while in the Thr-TIMI flow 0/1 group no
significant changes were recorded. A percent QTd decrease >30 s had 96%
sensitivity, 85% specificity, and 93% positive and 94% negative
predictive value, respectively, for TIMI 2/3 flow.
Conclusions: A significant decrease in QT dispersion may provide an
additional electrocardiographic index for successful (TIMI 2/3)
reperfusion.
ER -