Relation of Total Ischemic Time to Repolarization Indices and Their Impact on Outcomes Among STEMI Patients Undergoing Primary PCI

Обзор

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.

Подробное описание

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.

Вмешательства

• Лучевая терапия Echocardiography
  Simple, bedsides, non invasive

Первичные конечные точки

• Association between total ischemic time and ventricular repolarization indices [Срок оценки: 6 months]

Вторичные конечные точки (3)

• In-hospital ventricular arrhythmias [Срок оценки: 7 dayes]
• In-hospital major adverse cardiovascular events (MACE) [Срок оценки: 7 days]
• Six-month major adverse cardiovascular events (MACE) [Срок оценки: 6 months]

Критерии участия

Критерии включения

\- Patients presenting with acute STEMI undergoing primary PCI

Критерии исключения

\- 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

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• Wang X, Zhang L, Gao C, Zhu J, Yang X. Tpeak-Tend/QT interval predicts ST-segment resolution and major adverse cardiac events in acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Medicine (Baltimore). 2018 Oct;97(43):e12943. doi: 10.1097/MD.0000000000012943. PMID 30412109
• Rao SV, O'Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, Baber U, Baker H, Cohen MG, Cruz-Ruiz M, Davis LL, de Lemos JA, DeWald TA, Elgendy IY, Feldman DN, Goyal A, Isiadinso I, Menon V, Morrow DA, Mukherjee D, Platz E, Promes SB, Sandner S, Sandoval Y, Schunder R, Shah B, Stopyra JP, Talbot AW, Taub PR, Williams MS. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patien PMID 40014670
• Demidova MM, Carlson J, Erlinge D, Azarov JE, Platonov PG. Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction. Int J Cardiol. 2019 Apr 1;280:80-83. doi: 10.1016/j.ijcard.2019.01.008. Epub 2019 Jan 4. PMID 30661844
• Abu Shajahan M, Mohideen B, P A J, Thaha SM, Ashraf AR, Nazar I, Nair RG, Fakhrudeen Mushthak S, Suresh AL. Prognostic Value of QTc Dispersion in Acute Myocardial Infarction. Cureus. 2025 Apr 23;17(4):e82846. doi: 10.7759/cureus.82846. eCollection 2025 Apr. PMID 40416232
• Cagdas M, Karakoyun S, Rencuzogullari I, Karabag Y, Yesin M, Uluganyan M, Gursoy MO, Artac I, Ilis D, Efe SC, Tasar O. Relationship between R-wave peak time and no-reflow in ST elevation myocardial infarction treated with a primary percutaneous coronary intervention. Coron Artery Dis. 2017 Jun;28(4):326-331. doi: 10.1097/MCA.0000000000000477. PMID 28207567

Идентификаторы

NCT: NCT07175259 · Repolarization indices PPCI

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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