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Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Publication ,  Journal Article
Tjandrawidjaja, MC; Fu, Y; Westerhout, CM; Wagner, GS; Granger, CB; Armstrong, PW; APEX-AMI Investigators,
Published in: Am J Cardiol
September 1, 2010

The prognostic value of myocardial infarct size estimation by QRS scoring in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is unclear. The standard 32-point Selvester QRS score on the discharge electrocardiogram (each point approximately 3% left ventricular mass) was calculated in 4,113 patients with STEMI who underwent primary PCI and survived to hospital discharge in the APEX-AMI trial. QRS scores were divided into tertiles, i.e., < or =3 (<10% myocardium), 4 to 7 (10% to 21% myocardium), and > or =8 (>21% myocardium). Adjusted associations between QRS score and 90-day outcomes (death and composite of death/congestive heart failure (CHF)/shock) were examined. Higher QRS scores were associated with male gender, higher heart rate, worse Killip class, noninferior infarct location, greater ST-segment deviation, and longer times to reperfusion. Higher QRS scores were also associated with impaired culprit artery flow before and after PCI and more frequent multivessel disease. Adverse outcomes occurred more often in patients with higher QRS scores (90-day death: 1.9%, QRS score 0 to 3; 3.4%, 4 to 7; 4.9%, > or =8; 90-day death/shock/CHF: 4.5%, 0-3; 7.8%, 4 to 7; 12.1%, > or =8). After multivariable adjustment, patients with higher QRS scores remained more likely to develop an adverse outcome versus those with QRS scores < or =3 (score 4 to 7, hazard ratios [HR] for death 2.08, 95% confidence interval [CI] 1.26 to 3.41; HR for death/CHF/shock 2.00, 95% CI 1.26 to 3.17; score > or =8, HR for death 2.57, 95% CI 1.56 to 4.24, HR for death/CHF/shock 2.93, 95% CI 1.84 to 4.67). In conclusion, infarct size as estimated by QRS scoring at hospital discharge is an independent and prognostically relevant metric in patients with STEMI undergoing primary PCI.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 1, 2010

Volume

106

Issue

5

Start / End Page

630 / 634

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Single-Chain Antibodies
  • Severity of Illness Index
  • Risk Factors
  • Predictive Value of Tests
  • Patient Discharge
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
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ICMJE
MLA
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Tjandrawidjaja, M. C., Fu, Y., Westerhout, C. M., Wagner, G. S., Granger, C. B., Armstrong, P. W., & APEX-AMI Investigators, . (2010). Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am J Cardiol, 106(5), 630–634. https://doi.org/10.1016/j.amjcard.2010.04.013
Tjandrawidjaja, Michael C., Yuling Fu, Cynthia M. Westerhout, Galen S. Wagner, Christopher B. Granger, Paul W. Armstrong, and Paul W. APEX-AMI Investigators. “Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.Am J Cardiol 106, no. 5 (September 1, 2010): 630–34. https://doi.org/10.1016/j.amjcard.2010.04.013.
Tjandrawidjaja, Michael C., et al. “Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.Am J Cardiol, vol. 106, no. 5, Sept. 2010, pp. 630–34. Pubmed, doi:10.1016/j.amjcard.2010.04.013.
Tjandrawidjaja MC, Fu Y, Westerhout CM, Wagner GS, Granger CB, Armstrong PW, APEX-AMI Investigators. Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am J Cardiol. 2010 Sep 1;106(5):630–634.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 1, 2010

Volume

106

Issue

5

Start / End Page

630 / 634

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Single-Chain Antibodies
  • Severity of Illness Index
  • Risk Factors
  • Predictive Value of Tests
  • Patient Discharge
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans