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The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction

Publication ,  Journal Article
Bao, MH; Armstrong, PW; Zheng, Y; Westerhout, CM; Siha, H; Welsh, RC
Published in: Experimental and Clinical Cardiology
January 1, 2014

Background: QT interval (QTc) prolongation and increased dispersion (cQTd) have been implicated as risk factors for sudden death. We examined their prognostic value in patients with ST-segment elevation myocardial infarction (STEMI) before and after reperfusion therapy as well as at hospital discharge. Methods: This study includes 153 STEMI patients either treated with primary percutaneous coronary intervention (PPCI) (n=70) or fibrinolysis (n=83 including 19 rescue PCI) within 6 hours of symptom onset. QTc, cQTd, and ST-segment elevation (SSTE) were measured at baseline, post-reperfusion, and hospital discharge. Composite in-hospital clinical events reported include death, shock and congestive heart failure. Results: QT metrics were not associated with the severity of ischemia, as quantified through SST elevation. Relative change in cQTd was weakly associated (R=0.19, p=0.02) with reperfusion success assessed by SST resolution at hospital discharge. Prolonged baseline QT metrics were correlated with an increased risk of clinical events with QTc >460ms and cQTd >65 correlated to a >10% risk of developing death, shock, and congestive heart failure. This risk tripled with every 40ms increase in cQTd (OR 2.88, 95% CI (1.05-7.89), p=0.039) after adjustment for age, heart rate, systolic blood pressure, and infarct site. The highest cQTd quartile (=69ms) had a composite event rate of 23.7% (p=0.027). Conclusions: Prolonged QTc and cQTd correlated to adverse clinical events in STEMI patients treated with PPCI and fibrinolysis. Although caution must be employed using arbitrary cut points; a baseline cQTd beyond an upper boundary of 65ms appears to denote significant risk of adverse in-hospital events.

Duke Scholars

Published In

Experimental and Clinical Cardiology

ISSN

1205-6626

Publication Date

January 1, 2014

Volume

20

Issue

1

Start / End Page

1464 / 1489

Related Subject Headings

  • Cardiovascular System & Hematology
 

Citation

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Bao, M. H., Armstrong, P. W., Zheng, Y., Westerhout, C. M., Siha, H., & Welsh, R. C. (2014). The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction. Experimental and Clinical Cardiology, 20(1), 1464–1489.
Bao, M. H., P. W. Armstrong, Y. Zheng, C. M. Westerhout, H. Siha, and R. C. Welsh. “The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction.” Experimental and Clinical Cardiology 20, no. 1 (January 1, 2014): 1464–89.
Bao MH, Armstrong PW, Zheng Y, Westerhout CM, Siha H, Welsh RC. The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction. Experimental and Clinical Cardiology. 2014 Jan 1;20(1):1464–89.
Bao, M. H., et al. “The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction.” Experimental and Clinical Cardiology, vol. 20, no. 1, Jan. 2014, pp. 1464–89.
Bao MH, Armstrong PW, Zheng Y, Westerhout CM, Siha H, Welsh RC. The prognostic relationship of qt interval and dispersion in patients with acute st elevation myocardial infarction. Experimental and Clinical Cardiology. 2014 Jan 1;20(1):1464–1489.

Published In

Experimental and Clinical Cardiology

ISSN

1205-6626

Publication Date

January 1, 2014

Volume

20

Issue

1

Start / End Page

1464 / 1489

Related Subject Headings

  • Cardiovascular System & Hematology