Primary Percutaneous Coronary Intervention, Repolarization Indices, ST Elevation (STEMI) Myocardial Infarction of Other Sites, Total Ischemic Time
Conditions
Brief summary
1. Evaluate The impact of early versus late presentation on electrocardiographic ventricular repolarization indices. 2. To assess the association between repolarization indices among early, late presentation in relation to in-hospital ventricular arrhythmias, in-hospital MACE, and 6 months MACE.
Detailed description
ST-elevation myocardial infarction (STEMI) remains a time-critical cardiovascular emergency. Early reperfusion is essential to reduce myocardial necrosis, preserve ventricular function, and improve survival outcomes. However, delayed presentation remains a significant problem, especially in developing countries, leading to larger infarct sizes and worse clinical outcomes. (Park J, Choi KH, Lee JM, et al. 2019) Ventricular repolarization indices including QT interval ( Measured from the onset of the QRS complex (beginning of Q wave or R if no Q visible)To the end of the T wave returning to the isoelectric line ), QT dispersion (QTD) ( Calculated as: QTD = QT{max} - QT{min}), corrected QT interval (QTc) Calculated using Bazett's formula: QTc = {QT}/{sqrt{RR}. Corrected QT dispersion (cQTD or QTcd) Calculated as: cQTD = QTc{max}- QTc{min}.TPE/QT ratio, Calculated as: {TPE/QT Ratio} = {TPE}/{QT}, T peak-to-Tend interval (TPE) ( Measured from the peak of the T wave To the end of the T wave returning to the isoelectric line ), are non-invasive markers of electrical instability and myocardial injury. Prolongation of these indices has been associated with worse microvascular perfusion (including the no-reflow phenomenon (Abdelmeguid AE, Abdelhamid SM, Abdelhameed KM, et al. 2023) and lower myocardial blush grade \[MBG\]) (Liu X, Li Y, Li D, et al. 2021) and higher rates of major adverse cardiovascular events (MACE). (Çağdaş M, Rencüzoğulları İ, Karakoyun S, et al. 2018, Abdelmeguid AE, Abdelhamid SM, Abdelhameed KM, et al. 2023, Liu X, Li Y, Li D, et al. 2021) There is limited data assessing the direct relationship between early vs late presentation, repolarization indices measured before and after PCI, and subsequent outcomes in STEMI patients, particularly in our local population. This study aims to fill this gap by investigating whether timing of presentation significantly affects repolarization indices and whether these indices can predict in-hospital and six-month clinical outcomes.
Interventions
RADIATIONEchocardiography
Simple, bedsides, non invasive
Sponsors
Assiut University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
\- Patients presenting with acute STEMI undergoing primary PCI
Exclusion criteria
\- 1. Prior myocardial infarction or CABG. 2. Left or right bundle branch block. 3. Atrial fibrillation. 4. Cardiac arrest or cardiogenic shock 5. Valvular heart disease (severe). 6. Use of QT-prolonging medications as anti-arrhythmic, anti-psychotic, anti-depressant and some types of antibiotics. 7\. Poor quality ECG tracings. 8. Chronic kidney disease stage ≥3. 9. Electrolyte abnormalities at admission 10. Undetermined date of pain
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Association between total ischemic time and ventricular repolarization indices | 6 months | Correlation between total ischemic time (symptom onset to balloon time) and ECG-derived repolarization parameters, including QT interval, corrected QT (QTc), Tpeak-Tend interval, and Tpeak-Tend/QT ratio. Analysis will evaluate linear correlations and threshold effects. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| In-hospital ventricular arrhythmias | 7 dayes | Occurrence of sustained ventricular tachycardia or ventricular fibrillation documented during index hospitalization. |
| In-hospital major adverse cardiovascular events (MACE) | 7 days | Composite of all-cause death, reinfarction (per universal definition of MI), and new or worsening heart failure during index hospitalization. |
| Six-month major adverse cardiovascular events (MACE) | 6 months | Composite of cardiovascular mortality, hospitalization for heart failure or recurrent ACS, and target lesion revascularization (TLR) at follow-up. |
Contacts
Primary ContactAhmed Monazea Menisy, Principal investigator
Outcome results
None listed