Distortion of the terminal portion of the QRS is predictor of shock after primary percutaneous coronary intervention for acute myocardial infarction

Comparison of in Hospital Outcome of Patients with and without Distorted Terminal Portion of QRS Complex on Initial Electrocardiogram in ST Segment Elevation Myocardial Infarction

“…8,9 The mean door to needle time was 3.9±1.13 hrs and 4.5±1.27 hrs in group I and group II respectively. These parameter did not show statistically significant difference between two groups (P value > 0.05 for these parameters) that also similar to other studies 4,10,11,12 . Time interval between onset of chest pain and thrombolysis is an important factor for outcome of the patients 13 .…”

“…Heart failure was 13.3% without QRS distortion group and 40.0% in distorted QRS group. These parameters showed difference were significant between two groups (P value < 0.05 for these parameters) and similar pattern had also been found among many other studies 4,8,11,14 . Patients with distorted QRS complex had absence of collateral blood flow, larger area of myocardial necrosis and difficult to salvage the jeopardized myocardium even after reperfusion therapy.…”

“…The odd ratio were more than one in gender, HTN, DM, time to thrombolysis, heart rate, location of acute MI. Results of current study had similarity with other study 4,11,12 . It indicates that the distorted QRS on ECG and Killip class were independent predictor of inhospital mortality and heart failure.…”

“…These parameters showed the higher Killip class in group II (p value < 0.05) which was observed by various study 4,8,11,14 . They stated that higher the Killip class indicate larger area of myocardial necrosis and higher incidence of heart failure and increase mortality.…”

Profound myocardial ischemia associated to occlusion of the right coronary artery

“…It is believed to be associated to profound myocardial ischemia, particularly in relation with occlusions of the left anterior descending coronary artery [1], and to the occurrence of malignant ventricular arrhythmia and sudden cardiac death [1,2]. We present the first case in which ST-elevation alternans is related to a single stenosis in the right coronary artery.Other electrocardiographic patterns in the setting of ST-elevation acute myocardial infarction have been associated with poor outcomes as the distortion of the terminal portion of the QRS complex, which is also present in this patient and is a strong predictor of cardiogenic shock [3].Close hemodynamic and cardiac rhythm monitoring should be warranted in patients showing these electrocardiographic patterns because it might be the prelude to adverse or fatal events. …”