, Volume 40, Issue 3, pp 521–527 | Cite as

Terminal QRS distortion and severity of coronary artery disease in ST-elevation myocardial infarction

  • E.M. Bakirci
  • K. Kalkan
  • H. Hamur
  • M. Buyuklu
  • M. Cetin
  • H. Degirmenci
  • H. Duman
  • Z. Kucuksu
  • I.H. Tanboga
  • E. Topal
e-Herz: Original article



Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS complex on electrocardiograms (ECGs) of patients with ST-segment elevation myocardial infarction (STEMI). Although the association between G3I and short- and long-term cardiovascular events is well established, its mechanism is unclear. We assessed the association between G3I on the admission ECG and SYNTAX score (SS) in patients with STEMI undergoing primary percutaneous coronary intervention.

Patients and methods

The study population consisted of 312 patients with STEMI. Baseline ECGs of the patients were analyzed for grade of ischemia; the online latest updated version (2.11) of the SS calculator was used to determine the SS (http://www.syntaxscore.com). Patients were divided into two groups according to their grade of ischemia: grade 2 ischemia (G2I) or G3I. Also, patients were classified according to their SS as SS < 22 (low) or SS ≥ 22 (high).


There were 211 patients in the low SS group and 101 patients in the high SS group. G3I was present in 31.1 % (n = 97) of the study population. SS was significantly higher in patients with G3I than in patients with G2I (20.1 ± 8.8 vs. 13.7 ± 7.1, p < 0.001). G3I was significantly higher in patients with high SS (50.5 % vs. 21.8 %, p < 0.001). Multivariate logistic regression analysis revealed that G3I (p < 0.001), diabetes (p = 0.013), age (p = 0.016), and anterior MI (p = 0.011), were independent predictors of high SS.


In conclusion, G3I was independently related to high SS. We suggest that elevated SS in patients with G3I may explain the relationship between G3I and the poor outcome observed in these patients. Furthermore, the prediction of high SS by means of G3I in patients with STEMI may help determine the most appropriate revascularization method and prevent procedure failure.


Acute myocardial infarction Electrocardiography Grade 3 ischemia Syntax score Percutaneous coronary intervention 

Terminaler QRS-Verformung und Schweregrad der koronaren Herzkrankheit bei ST-Hebungs-Infarkt



Eine Ischämie 3. Grades (G3I) ist definiert als ST-Hebung mit Verformung des terminalen Anteils des QRS-Komplexes im EKG von Patienten mit ST-Strecken-Hebungs-Infarkt (STEMI). Zwar ist der Zusammenhang zwischen G3I und kurz- sowie langfristigen kardiovaskulären Ereignissen wohl bekannt, aber sein Mechanismus ist noch nicht klar. Hier wurde der Zusammenhang zwischen einer G3I im Aufnahme-EKG und dem Syntax-Score (SS) bei Patienten mit STEMI ermittelt, bei denen eine primäre perkutane Koronarintervention erfolgte.

Patienten und Methoden

Die Studienpopulation bestand aus 312 Patienten mit STEMI. Das Ausgangs-EKG der Patienten wurde im Hinblick auf den Grad der Ischämie ausgewertet; zur Berechnung des SS wurde die letzte online aktualisierte Version (2.11) verwendet (http://www.syntaxscore.com). Je nach Grad der Ischämie wurden die Patienten in 2 Gruppen unterteilt: Ischämie 2. Grades (G2I) oder G3I. Außerdem wurden die Patienten nach ihrem SS eingestuft: SS < 22 (niedrig) und SS ≥ 22 (hoch).


Es gab 211 Patienten in der Gruppe mit niedrigem SS und 101 Patienten in der Gruppe mit hohem SS. Eine G3I bestand bei 31,1 % (n = 97) der gesamten Population. Der SS war bei Patienten mit G3I signifikant höher als bei Patienten mit G2I (20,1 ± 8,8 vs. 13,7 ± 7,1; p < 0,001). Die G3I war bei Patienten mit hohem SS signifikant höher als bei den übrigen (50,5 % vs. 21,8 %; p < 0,001). Die multivariate logistische Regressionsanalyse ergab, dass G3I (p < 0,001), Diabetes (p = 0,013), Alter (p = 0,016) und Vorderwandinfarkt (p = 0,011) unabhängige Prädiktoren eines hohen SS waren.


Fazit ist, dass eine G3I unabhängig mit einem hohen SS vergesellschaftet war. Die Autoren stellten die These auf, dass ein erhöhter SS bei Patienten mit G3I einen Mechanismus zur Erklärung des Zusammenhangs zwischen G3I und dem ungünstigen Verlauf bei diesen Patienten darstellen könne. Außerdem trägt die Vorhersage eines hohen SS anhand einer G3I bei Patienten mit STEMI möglicherweise dazu bei, das am besten geeignete Revaskularisierungsverfahren zu ermitteln und einem Versagen der Intervention zu vorzubeugen.


Akuter Herzinfarkt Elektrokardiographie Grad-3-Ischämie Syntax-Score Perkutane Koronarintervention 


Compliance with ethical guidelines

Conflict of interest. E.M. Bakirci, K. Kalkan, H. Hamur, M. Buyuklu, M. Cetin, H. Degirmenci, H. Duman, Z. Kucuksu, I.H. Tanboga, and E. Topal state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.


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Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  • E.M. Bakirci
    • 1
  • K. Kalkan
    • 2
  • H. Hamur
    • 1
  • M. Buyuklu
    • 1
  • M. Cetin
    • 3
  • H. Degirmenci
    • 1
  • H. Duman
    • 2
  • Z. Kucuksu
    • 1
  • I.H. Tanboga
    • 2
  • E. Topal
    • 1
  1. 1.Department of Cardiology, Faculty of MedicineErzincan UniversityErzincanTurkey
  2. 2.Department of Cardiology, Faculty of MedicineAtaturk UniversityErzurumTurkey
  3. 3.Department of Cardiology, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey

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