Güney ERDOĞAN, Uğur ARSLAN, Mustafa YENERÇAĞ, Diyar KÖPRÜLÜ, Ender Özgün ÇAKMAK, Ali KARAGÖZ, Elnur ALİZADE

ST-Yükselmeli Miyokart Enfarktüsünde Frontal QRST Açısı ile Trombüs Yükü Arasındaki İlişki

Giriş: ST-yükselmeli miyokart enfarktüsü (STEMI) gelişen hastalarda frontal QRST açısı ile koroner arter hastalığının yaygınlığı, şiddeti ve karmaşıklığı arasındaki ilişkisine rağmen bugüne kadar özellikle frontal QRST açısının trombüs yükü ile olan ilişkisine değinen hiçbir çalışma yoktur. Bu çalışmanın amacı, STEMI gelişen hastalarda frontal QRST açısı ile trombüs yükü arasında bir ilişki olup olmadığını değerlendirmektir. Hastalar ve Yöntem: Bu retrospektif kesitsel analizde, primer perkütan koroner girişim uygulanan 192 STEMI hastası TIMI trombüs derecesine göre ayrılmıştır. Çalışmaya, yüksek trombüs yükü olanlar (46 hasta) ve düşük trombüs yükü olanlar (146 hasta) dahil edilmiştir. Trombüs yükü, miyokard infarktüsü trombüs derecelerinde trombolize göre kategorize edilmiştir. Frontal QRST açısı, EKG’ye göre frontal düzlem QRS ve T eksenleri arasındaki farkın mutlak değeri olarak hesaplanmıştır. Bulgular: Çok değişkenli analizde frontal QRST açısı (OR= 1.270, %95 CI= 1.140-1.410, p= 0.001), C-reaktif protein (OR= 1.185, %95 CI= 1.015-1.383, p= 0.032) ve troponin I seviyesi (OR= 1.295, %95 CI= 1.091-1.536, p= 0.003) yüksek trombüs yükünün bağımsız öngördürücüleriydi. ROC analizinde yüksek trombüs yükünü tahmin etmek için frontal QRST açısının sınır değeri %76 duyarlılığa, %74 özgüllüğe sahip olarak 76.5 [eğri altında kalan alan (AUC)= 0.76, p< 0.001] bulunmuştur. Sonuç: Frontal QRST açısı STEMI’de yüksek trombüs yükünü tahmin etmede yararlı bir araçtır

The Relationship Between the Frontal QRST Angle and Thrombus Burden in ST-Elevated Myocardial Infarction

Introduction: Despite the relevance of the frontal QRST angle to the distribution, grade, and complexity of coronary artery disease in ST-elevated myocardial infarction (STEMI), until now no studies have particularly addressed the association of frontal QRST angle with thrombus burden in STEMI. The goal of this study was to assess whether a relevance exists between the frontal QRST angle and the thrombus burden in STEMI. Patients and Methods: In this retrospective cross-sectional analysis, 192 STEMI patients who underwent primary percutaneous coronary intervention were separated according to TIMI thrombus grade; those with a high thrombus burden (46 patients) and those with a low thrombus burden (146 patients) included. Thrombus burden was categorized according to thrombolysis in myocardial infarction (TIMI) thrombus grades. Frontal QRST angle calculation was done as the absolute value of the difference of the QRS and T axes. Results: In multivariable analysis, frontal QRST angle (OR= 1.270, 95% CI= 1.140-1.410, p= 0.001), C-reactive protein (OR= 1.185, 95% CI= 1.015-1.383, p= 0.032), and troponin I (OR= 1.295, 95% CI= 1.091-1.536, p= 0.003) were independently associated with high thrombus burden. In ROC analysis, the value of 76.5 for frontal QRST angle had 76% sensitivity and 74% specificity [area under curve (AUC)= 0.76, p< 0.001] for the estimation of high thrombus burden in STEMI. Conclusion: Frontal QRST angle is a useful tool to detect high thrombus burden in STEMI.

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