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

Güney Erdoğan1, Mustafa Yenerçağ2, Diyar Köprülü3, Özgün Çakmak4, Uğur Arslan1, Ali Karagöz4, Elnur Alizade4

1Department of Cardiology, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
2Department of Cardiology, Ordu University Training and Research Hospital, Ordu, Turkey
3Department of Cardiology, Ordu State Hospital, Ordu, Turkey
4Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey

Keywords: Frontal QRST angle; thrombus burden; ST-elevated myocardial infarction.

Abstract

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.

Ethics Committee Approval

This study was approved by Samsun Training and Research Hospital Non-Invasive Clinical Research Ethics Committee (2021/1/5, Date: 13.01.2021).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - GE, UA; Analysis/Interpretation - UA, MY; Data Collection - GE, DK; Writing - GE, UA; Critical Revision - ÖÇ, EA; Statistical Analysis - AK; Overall Responsibility - GE; Final Approval - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.