Relationship of QRS duration at baseline and changes over 60 min after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction: Results from the hirulog and early reperfusion or occlusion-2 trial

C. K. Wong, W. Gao, R. A H Stewart, J. K. French, P. E G Aylward, H. D. White

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective: To discern if the prognostic meaning of QRS prolongation differs according to the location of ST elevation acute myocardial infarction Design: Measuring QRS duration in patients with normal conduction or right bundle branch block Setting: HERO-2 trial with prospective collection of electrocardiograms at randomisation and at 60 min after fibrinolytic therapy Patients: 12 456 patients with normal conduction at both randomisation and 60-min time points and 510 with right bundle branch block (RBBB) at both time points Main outcome measure: 30-day mortality. Results: On the baseline ECG, there was a positive association between QRS duration and 30-day mortality with anterior acute myocardial infarction (AMI) (p<0.0001 for those with normal conduction and = 0.007 for those with RBBB) but not with inferior AMI (p = 0.29 and p = 0.32, respectively). For anterior AMI, with or without RBBB, an increment of 20 ms increase in QRS duration predicted a significant 30-40% relative increase in 30-day mortality both before and after adjusting for clinical and ECG variables including baseline ST elevation and presence of Q waves. The association was not present for inferior AMI. Changes in QRS duration over 60 min after fibrinolytic therapy were uncommon and unrelated to mortality. Conclusion: Baseline QRS duration independently stratifies 30-day mortality in patients with anterior AMI, even when unaccompanied by RBBB, but does not stratify mortality risk in patients with inferior AMI.

LanguageEnglish
Pages276-282
Number of pages7
JournalHeart
Volume95
Issue number4
DOIs
Publication statusPublished - 1 Feb 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{dfc38b01df58482a9fb4eea5ec632ca1,
title = "Relationship of QRS duration at baseline and changes over 60 min after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction: Results from the hirulog and early reperfusion or occlusion-2 trial",
abstract = "Objective: To discern if the prognostic meaning of QRS prolongation differs according to the location of ST elevation acute myocardial infarction Design: Measuring QRS duration in patients with normal conduction or right bundle branch block Setting: HERO-2 trial with prospective collection of electrocardiograms at randomisation and at 60 min after fibrinolytic therapy Patients: 12 456 patients with normal conduction at both randomisation and 60-min time points and 510 with right bundle branch block (RBBB) at both time points Main outcome measure: 30-day mortality. Results: On the baseline ECG, there was a positive association between QRS duration and 30-day mortality with anterior acute myocardial infarction (AMI) (p<0.0001 for those with normal conduction and = 0.007 for those with RBBB) but not with inferior AMI (p = 0.29 and p = 0.32, respectively). For anterior AMI, with or without RBBB, an increment of 20 ms increase in QRS duration predicted a significant 30-40{\%} relative increase in 30-day mortality both before and after adjusting for clinical and ECG variables including baseline ST elevation and presence of Q waves. The association was not present for inferior AMI. Changes in QRS duration over 60 min after fibrinolytic therapy were uncommon and unrelated to mortality. Conclusion: Baseline QRS duration independently stratifies 30-day mortality in patients with anterior AMI, even when unaccompanied by RBBB, but does not stratify mortality risk in patients with inferior AMI.",
author = "Wong, {C. K.} and W. Gao and Stewart, {R. A H} and French, {J. K.} and Aylward, {P. E G} and White, {H. D.}",
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Relationship of QRS duration at baseline and changes over 60 min after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction : Results from the hirulog and early reperfusion or occlusion-2 trial. / Wong, C. K.; Gao, W.; Stewart, R. A H; French, J. K.; Aylward, P. E G; White, H. D.

In: Heart, Vol. 95, No. 4, 01.02.2009, p. 276-282.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relationship of QRS duration at baseline and changes over 60 min after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction

T2 - Heart

AU - Wong, C. K.

AU - Gao, W.

AU - Stewart, R. A H

AU - French, J. K.

AU - Aylward, P. E G

AU - White, H. D.

PY - 2009/2/1

Y1 - 2009/2/1

N2 - Objective: To discern if the prognostic meaning of QRS prolongation differs according to the location of ST elevation acute myocardial infarction Design: Measuring QRS duration in patients with normal conduction or right bundle branch block Setting: HERO-2 trial with prospective collection of electrocardiograms at randomisation and at 60 min after fibrinolytic therapy Patients: 12 456 patients with normal conduction at both randomisation and 60-min time points and 510 with right bundle branch block (RBBB) at both time points Main outcome measure: 30-day mortality. Results: On the baseline ECG, there was a positive association between QRS duration and 30-day mortality with anterior acute myocardial infarction (AMI) (p<0.0001 for those with normal conduction and = 0.007 for those with RBBB) but not with inferior AMI (p = 0.29 and p = 0.32, respectively). For anterior AMI, with or without RBBB, an increment of 20 ms increase in QRS duration predicted a significant 30-40% relative increase in 30-day mortality both before and after adjusting for clinical and ECG variables including baseline ST elevation and presence of Q waves. The association was not present for inferior AMI. Changes in QRS duration over 60 min after fibrinolytic therapy were uncommon and unrelated to mortality. Conclusion: Baseline QRS duration independently stratifies 30-day mortality in patients with anterior AMI, even when unaccompanied by RBBB, but does not stratify mortality risk in patients with inferior AMI.

AB - Objective: To discern if the prognostic meaning of QRS prolongation differs according to the location of ST elevation acute myocardial infarction Design: Measuring QRS duration in patients with normal conduction or right bundle branch block Setting: HERO-2 trial with prospective collection of electrocardiograms at randomisation and at 60 min after fibrinolytic therapy Patients: 12 456 patients with normal conduction at both randomisation and 60-min time points and 510 with right bundle branch block (RBBB) at both time points Main outcome measure: 30-day mortality. Results: On the baseline ECG, there was a positive association between QRS duration and 30-day mortality with anterior acute myocardial infarction (AMI) (p<0.0001 for those with normal conduction and = 0.007 for those with RBBB) but not with inferior AMI (p = 0.29 and p = 0.32, respectively). For anterior AMI, with or without RBBB, an increment of 20 ms increase in QRS duration predicted a significant 30-40% relative increase in 30-day mortality both before and after adjusting for clinical and ECG variables including baseline ST elevation and presence of Q waves. The association was not present for inferior AMI. Changes in QRS duration over 60 min after fibrinolytic therapy were uncommon and unrelated to mortality. Conclusion: Baseline QRS duration independently stratifies 30-day mortality in patients with anterior AMI, even when unaccompanied by RBBB, but does not stratify mortality risk in patients with inferior AMI.

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DO - 10.1136/hrt.2008.146365

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JO - Heart

JF - Heart

SN - 1355-6037

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