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Terminal QRS Complex Distortion on the Admission Electrocardiogram in Anterior Acute Myocardial Infarction and Association with Residual Flow and Infarct Size after Primary Angioplasty

The Korean journal of internal medicine : KJIM v.20 no.1 , 2005년, pp.21 - 25  
Yang, Hyun Suk (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Lee, Cheol Whan ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Hong, Myeong-Ki ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Moon, Dae-Hyuk ( Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Kim, Young-Hak ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Lee, Sang-Gon ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Han, Ki-Hoon ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Kim, Jae-Joong ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Park, Seong-Wook ( Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. ) ;  Park, Seung-Jung ( De)
Abstract

BackgroundTerminal QRS complex distortion on admission is a simple and reliable predictor of infarct size in patients with acute myocardial infarction (AMI). It is uncertain, however, whether this reflects reduced myocardial perfusion of the infarct area and a larger area of the myocardium at risk. This study was conducted to investigate whether terminal QRS distortion complex on admission is a reliable predictor of reduced residual flow and a larger area of the myocardium at risk compared to patients who are admitted without a terminal QRS distortion.MethodsWe evaluated the relationship between terminal QRS complex distortion and residual flow to the infarct zone and risk area in 46 anterior AMI patients undergoing primary angioplasty. 99mTc-sestamibi imaging was performed at baseline and 5-9 days after angioplasty. The study population was divided into those with (Group I, n=16) and without (Group II, n=30) terminal QRS complex distortion.ResultsBaseline characteristics were similar between the two groups. The area of the myocardium at risk was higher in Group I (59.9±15.3%) than in Group II (48.6±13.7%, p<0.05; mean+SD) while the nadir measurement of the residual flow was lower in Group I (0.10±0.07) than in Group II (0.16±0.09, p<0.05). Although the final infarct size was significantly higher in Group I (40.8±17.2%) than in Group II (27.1±18.1%, p<0.05), the myocardial salvage index did not differ significantly between the two groups.ConclusionTerminal QRS complex distortion seems to be associated with less residual flow to the infarct zone, a larger risk area and greater infarct size in patients with anterior AMI.

주제어

#Myocardial infarction   #QRS distortion   #Angioplasty  

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