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    Öğe
    Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions
    (Churchill Livingstone Inc Medical Publishers, 2008) Maden, Orhan; Kacmaz, Fehml; Selcuk, Mehmet Timur; Selcuk, Hatice; Alyan, Oemer; Aksu, Tolga; Metin, Fatma
    Background: Although QRS-complex changes during ischemia have been described previously, their relation with no-reflow is not clear. Purpose: To evaluate relation of admission QRS duration with angiographic no-reflow, we studied 162 patients who underwent primary angioplasty. Methods: Twelve-lead electrocardiogram with a paper speed of 50 mm/s was recorded on admission and repeated after angioplasty. Patients were divided into reflow and no-reflow groups based on postangioplasty coronary thrombolysis in myocardial infarction flow grade. Results: Patients in the no-reflow group (26 patients) were older (P = .001) and had significantly longer pain-to-balloon interval (P = .007). The patients in the no-reflow group had significantly longer QRS duration on admission electrocardiogram compared with patients in the reflow group (interquartile range, 80-93 [median, 84] milliseconds vs 60-80 [median, 76] milliseconds, respectively; P < .001). After adjusting all variables, QRS duration on admission was found to be independently related to angiographic no-reflow (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .003). Conclusion: QRS duration on admission may be valuable in predicting no-reflow. (C) 2008 Elsevier Inc. All rights reserved.
  • [ X ]
    Öğe
    Relationship of admission QRS duration and changes in QRS duration with myocardial reperfusion in patients with acute ST segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy
    (Japanese Circulation Soc, 2008) Kacmaz, Fehmi; Maden, Orhan; Celebi, Savas Aksuyek; Ureyen, Cagin; Alyan, Oemer; Erbay, Ali Riza; Selcuk, Hatice
    Background Although ischemia induced QRS complex changes have been described previously, their relationship with impaired reperfusion, which is known to be associated with poor clinical outcomes, is not clear. Methods and Results To investigate the relationship of QRS duration changes with myocardial reperfusion, we studied 165 acute myocardial infarction (MI) patients who were administered fibrinolytic therapy for reperfusion. For each patient, 12-lead electrocardiogram (ECG) with a paper speed of 50mm/s was recorded on admission and repeated at the 60(th) and 90(th) min following fibrinolytic therapy. Based on the myocardial blush grades obtained from a control coronary angiography, patients were divided into reperfusion (grades 2, 3) and impaired reperfusion (grades 0, 1) groups. We detected impaired reperfusion in 74 patients. The patients in the impaired reperfusion group were older, more often diabetic, and had longer pain-to-needle intervals. They also had significantly longer QRS durations at admission compared to reperfusion group patients (91 +/- 11 vs 79 +/- 11ms, p<0.001). Reperfusion group patients showed significantly greater resolution in QRS duration at the 90(th) min post fibrinolysis ECG (18 +/- 5 vs 5 +/- 4ms, p<0.001). In regression analysis, the pain-to-needle time (odds ratio (OR): 0.55, 95% confidence interval (CI) 0.35-0.88, p=0.012), QRS duration on admission (OR: 0.80, 95% CI 0.67-0.97, p=0.021), and change in QRS duration at the post fibrinolysis 90(th) min ECG (OR: 2.43, 95%CI, 1.29-4.60, p=0.006) were determined as independent predictors of adequate reperfusion. Conclusion The present study, for the first time, has shown that admission QRS duration and post fibrinolysis 90(th) min QRS duration changes are related to tissue reperfusion in fibrinolytic administered acute MI patients.