Terminal QRS Distortion on Admission ECG as a Predictor for Major Cardiovascular Adverse Events during Hospitalization in Patient with ST Segment Elevation Myocardial Infarction in Haji Adam Malik General Hospital

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Kamal Kharrazi Ilyas
Zainal Safri
Harris Hasan
Zulfikri Mukhtar
Nizam Zikri Akbar
Andika Sitepu


Background: Mortality in patient with acute myocardial infarction has decreased due to evolution in management system in patient with acute coronary syndrome, but mortality rate during hospitalization remains high, especially STEMI. Electrocardiography (ECG) has a role for diagnosing and predict prognosis in acute myocardial infarction. Terminal QRS distortion defined as J point elevation more than 50% of R wave in lead with qR configuration and/or loss of S wave with RS configuration. Changes of terminal QRS segment believed to be caused by electrical conduction elongation in Purkinje fiber or myocardial ischemic zone that represent severe ischemia. The purpose of this study is to assess the role of terminal QRS distortion as one of the parameter to predict major adverse cardiovascular events during hospitalization in ST elevation myocardial infarction in RSUP H. Adam Malik

Methods: This is a ambispective observational study consist of STEMI patients who were hospitalized from Mei 2019 to September 2019. All subjects diagnosed with STEMI and already fulfilled the inclusion and exclusion criterias. The terminal QRS distortion on the ECGs was assessed when the patient came to emergency departement. Then during hospitalization, the patients will undergo intervention and then observed during hospitalization for MACE occurrence.

Results: Of the 78 STEMI patients, 44 people had terminal QRS distortion and 34 did not have terminal QRS distortion. In group with terminal QRS distortion, 27 people experiences MACE. From the correlation analysis, there is positive correlation between terminal QRS distortion with MACE with correlation coefficient 0.317 (p value < 0.001). Multivariate analysis for most significant variable for MACE occurrence shows that terminal QRS distortion can predict MACE (OR 3.66 [1.317-10.166], 95% CI, p = 0.013)

Conclusion: Terminal QRS distortion found in ECG at admission in STEMI patient correlate with major adverse cardiovascular event during hospitalization.

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