ST Elevation Myocardial Infarction Clinical Trial
Official title:
Correlation of QT Dispersion With Myocardial Perfusion in Patients With ST Elevation Myocardial Infarction Treated by Primary Per Cutaneous Coronary Intervention
To correlate QT dispersion on 12-lead surface ECG with myocardial reperfusion evaluated by myocardial blush grade and Thrombolysis in myocardial infarction (TIMI) flow grades in patients with ST elevation myocardial infarction treated by Primary Per cutaneous coronary intervention
Worldwide, coronary artery disease (CAD) is the most frequent cause of death. Over seven
million people every year die from CAD, accounting for 12.8% of all deaths. Every sixth man
and every seventh woman in Europe die from myocardial infarction. The in-hospital mortality
of STEMI patients in the national registries of the European society of cardiology (ESC)
countries varies between 6% and 14%.
ST elevation myocardial infarction (STEMI) generally results from intraluminal thrombus
formation and occlusion of a ruptured or an unstable plaque .
The main goal of therapy in STEMI is to restore microvascular flow and sustain the myocardial
perfusion .
Reperfusion therapy for acute myocardial infarction (AMI) is aimed at achieving prompt
restoration of myocardial perfusion to maximize preservation of the electrical and mechanical
integrity of the jeopardized myocardium. Percutaneous coronary intervention (PCI) has
increased the rate of successful recanalization of infarct-related arteries (IRAs) to >90% .
A variety of markers including ECG and coronary angiography have been utilized to assess
myocardial reperfusion .
The prolongation of QRS duration,evaluated by a standard 12-lead ECG, is a marker of
ventricular dysfunction and has been associated with a poor prognosis in STEMI .
QT-interval parameters are potentially proposed as available non-invasive markers for
assessing the ventricular homogeneity as well as for predicting electrical instability ,QT
interval (QTI) is defined as the longest interval from the beginning of the QRS complex to
the end of the T-wave; QT dispersion (QTd) is defined as the difference between the longest
and shortest QTI, and reflects electrical activity of the ventricles . .
The prolongation of the latter parameter is a main predictor for fatal arrhythmia in patients
with myocardial infarction (MI) .
The measurement of QTI and QTd parameters are dependent on heart rate and can be corrected by
the QT correction formulas, which are termed the corrected QTI (QTc) and QTd (QTcd) .
Myocardial blush grade (MBG) is validated measurement of myocardial perfusion . The MBG is
used to assess the washout of myocardial blush during angiography. Grade 0 is defined as the
failure of the contrast to enter the microvasculature. In grade 1 cases, contrast enters
slowly, but fails to exit the microvasculature. Grade 2 defines delayed entry and exit from
the microvasculature. Finally, grade 3 indicates normal entry and exit from the
microvasculature .
ECG is a necessary, simple, rapid and non invasive tool for the diagnosis of myocardial
infarction and evaluation of myocardial reperfusion that still to be investigated . QT
dispersion is a crude and approximate measure of a general abnormality of repolarization; it
reflects inhomogeneity of ventricular repolarization . This measurement is an attempt to
distinguish between myocardium that is homogeneous from myocardium that displays
inhomogeneity, which is accompanied by increased dispersion of the ventricular recovery times
and prolongation of repolarization
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