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QRS Infarct Scoring Is Good Prognostic Indicator

Using discharge ECG, score predicts outcomes in STEMI patients treated with PCI

FRIDAY, Sept. 3 (HealthDay News) -- Infarct size estimated by QRS scoring on discharge electrocardiogram is a prognostic indicator in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), according to a study published in the Sept. 1 issue of the American Journal of Cardiology.

Michael C. Tjandrawidjaja, M.D., of the University of Alberta in Edmonton, Canada, and colleagues used the standard 32-point Selvester QRS scoring system on the discharge electrocardiogram to calculate scores for 4,113 patients with STEMI who underwent primary PCI and survived to hospital discharge. The purpose of the study was to establish the prognostic value of the QRS score related to the outcome of death and a composite outcome of death/congestive heart failure/shock.

The researchers found that adverse 90-day outcomes occurred more frequently in patients with higher QRS scores (90-day death: 1.9 percent of those with the lowest QRS scores compared to 4.9 percent of those with the highest QRS scores). This association also held for the QRS score and 90-day composite death/congestive heart failure/shock outcomes (4.5 versus 12.1 percent). After adjustment, in comparison to QRS scores of three or less, the hazard ratio (HR) for death for patients with QRS scores of four to seven was 2.08, and the HR for death for patients with scores of eight or greater was 2.57; the HRs for the composite outcome in these two groups were 2.00 and 2.93, respectively.

"Previous studies have examined the prognostic value of predischarge QRS scoring among patients with STEMI. These studies were conducted in an era before the advent of routine primary PCI," the authors write. "Our study complements the literature by showing the continued importance of infarct size quantification by QRS scoring in a large and well-characterized contemporary population of patients with STEMI treated with primary PCI."

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