Akut Q dalgasız miyokart infarktüsü geçiren hastalarda elektrokardiyografi ve sol ventrikül duvar hareket skor indeksinin kısa dönem prognostik öneminin değerlendirilmesi

Abstract

Evaluation of Short-Term Prognostic Significance of Electrocardiography and Left Ventricular Wall Motion Score Index in Acute Non-Q Myocardial infarct Patients AIM: Aim of this study is to assess the short-term (in-hospital) risk of acute non-Q wave myocardial infarct patients by electrocardiography and echocardiographic "Left Ventricular Wall Motion Score Index (LWMSI)" and "Wall Motion Abnormality (WMA)". Correlations between severity and extension of coronary artery disease, need for revascularization and these echocardiographic parameters were also investigated. MATERIAL AND METHODS: 76 patients with acute non-Q wave Ml were included in this study. LWMSI and WMA are measured with two-dimensional echocardiographic examination in the first 48 hours. Admission electrocardiographic findings (ST segment depression, T wave inversion, non-specific ECG etc.) were noted. On the basis of their LWMSI, patients were divided into 3 groups: LVWMSK1.50, LWMSI=1.5-1.9 and LVWMSI>=2.0. And according to WMA, 3 groups were determined: WMA=0-5, WMA=6-10 and WMA=1 1-16 segments. All patients were analyzed by coronary angiography for severity and extension of coronary artery disease. Ejection fraction of two thirds of patients were determined. End points were death, reinfarct, recurrent angina, congestive heart failure and arrhytmias. RESULTS: End points were reached in 21 (27.6%) of patients. Complications were observed especially in those patients whose LWMSM.5 and WMA>5 segments (p=0.001). Especially, death and congestive heart failure were found to occur in this group of patients. And also in-hospital complications were increased in ST segment depression group. All of death and congestive heart failure end points were also observed in ST segment depression patients. The patients who had a complicated course were older than those who showed a good outcome (64.7±1 0.3 vs 58.2±1 1.0, p=0.02). LWMSI and WMA predicted multivessel disease and requirement for revascularization (X2=20.7, p=0.001 and X2=28.9, p=0.001). In these subsets of patients more coronary angiography, PTCA and coronary artery bypass grafting were performed. There was no evident correlation between ECG findings and coronary angiographic severity of atherosclerosis. High CKMB levels and low ejection fraction were determined in patients whose LWMSM.5 (p<0.01, R=+0.45 and p=0.004, R-0.65). Similar data were seen in the ST segment depression goup (p<0.05, p<0.05). CONCLUSION: Our results suggest that admission electrocardiography and echocardiography are practical tools for risk stratification in acute non-Q wave myocardial infarct patients. According to our findings, patients with old age, ST segment depression, WMA>5 and LWMSM.5 in echocardiography are more prone to adverse cardiac events in the near future. Early coronary angiography and revascularization methods in these subsets of patients may positively affect short-term prognosis.