Prognostic value of frontal QRST angle and in hospital outcome in ST- Segment Elevation Myocardial Infarction patients undergoing primary percutaneous coronary angioplasty

Authors

  • Arjun Budhathoki National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal https://orcid.org/0000-0003-4356-3439
  • Arun Maskey Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Rabi Malla Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Sujeeb Rajbhandari Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Dipika Basnet Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
  • Rabindra Simkhada Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Rikesh Tamrakar Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Krishna Chandra Adhikari National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal
  • Bishal Shrestha National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal
  • Chitra Raj Sharma National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal
  • Manoj Koirala National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal
  • Shreya Bhandari Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Shipra Shrestha Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
  • Bishow Raj Baral National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

DOI:

https://doi.org/10.3126/njh.v18i2.40396

Keywords:

acute ST elevation myocardial infarction, frontal QRST angle, In-hospital Mortality, primary percutaneous coronary angioplasty

Abstract

Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance.

Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 (>90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3(>90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant.

Conclusion:  Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.

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Author Biographies

Arjun Budhathoki, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

Arun Maskey, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Rabi Malla, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Sujeeb Rajbhandari, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Dipika Basnet, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal

Department of Pathology

Rabindra Simkhada, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Rikesh Tamrakar, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Krishna Chandra Adhikari, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

Bishal Shrestha, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

Chitra Raj Sharma, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

Manoj Koirala, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

Shreya Bhandari, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Shipra Shrestha, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Department of Cardiology

Bishow Raj Baral, National Academy of Medical Sciences, Mahaboudhha, Kathmandu, Nepal

Department of Cardiology

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Published

2021-11-23

How to Cite

Budhathoki, A., Maskey, A., Malla, R., Rajbhandari, S., Basnet, D., Simkhada, R., Tamrakar, R., Adhikari, K. C., Shrestha, B., Sharma, C. R., Koirala, M., Bhandari, S., Shrestha, S., & Baral, B. R. (2021). Prognostic value of frontal QRST angle and in hospital outcome in ST- Segment Elevation Myocardial Infarction patients undergoing primary percutaneous coronary angioplasty. Nepalese Heart Journal, 18(2), 21–25. https://doi.org/10.3126/njh.v18i2.40396

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Section

Original Articles