Document Detail


Distortion of the terminal portion of the QRS is predictor of shock after primary percutaneous coronary intervention for acute myocardial infarction.
MedLine Citation:
PMID:  18068246     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although invasive management of ST segment elevation myocardial infarction has improved the clinical outcome, cardiogenic shock (CS) remains an important issue. Our purpose was to asses the utility of the initial electrocardiogram in detecting patients who are at increased risk of CS after percutaneous coronary intervention for acute myocardial infarction. METHODS: We evaluated 508 consecutive patients admitted in our Coronary Unit and treated by primary angioplasty within 12 h of an ST segment elevation myocardial infarction. Patients with cardiogenic shock at admission were excluded. Two groups were defined according to the presence of distortion of the terminal portion of the QRS in two or more adjacent leads (group 1) or the absence of this pattern (group 2). RESULTS: There were 99 patients (20%) in group 1 and 409 (80%) in group 2. CS developed in 38 patients, 18 in group 1 (18%) and 20 in group 2 (5%), p<0.001. Seventeen patients died in hospital, 6 in group 1 (6%) and 11 in group 2 (3%), p 0.094. Multivariate analysis including clinical, electrocardiographic and angiographic variables showed distortion of the QRS as an independent predictor of cardiogenic shock (odds ratio 3.17, 95% confidence interval 1.44 to 6.96, p 0.004), together with Killip class at admission and TIMI 3 flow after revascularization. CONCLUSIONS: Distortion of the terminal portion of the QRS complex is a strong predictor of cardiogenic shock in STEMI patients. Close hemodynamic monitoring should be warranted in patients showing this electrocardiographic pattern.
Authors:
Juan C Garcia-Rubira; Rafael Garcia-Borbolla; Ivan Nuñez-Gil; Maria C Manzano; Maria M Garcia-Romero; Antonio Fernandez-Ortiz; Leopoldo Perez de Isla; Carlos Macaya
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-12-18
Journal Detail:
Title:  International journal of cardiology     Volume:  130     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-05     Completed Date:  2009-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  241-5     Citation Subset:  IM    
Affiliation:
Instituto Cardiovascular, Hospital San Carlos, Madrid, Spain. drchjcgr@arrakis.es
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / methods*,  standards
Electrocardiography / methods*,  standards
Female
Humans
Male
Middle Aged
Myocardial Infarction / physiopathology,  therapy
Predictive Value of Tests
Prospective Studies
Shock, Cardiogenic / etiology*,  physiopathology*

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