TY - JOUR
T1 - The electrocardiographic “triangular QRS-ST-T waveform” pattern in patients with ST-segment elevation myocardial infarction
T2 - Incidence, pathophysiology and clinical implications
AU - Cipriani, Alberto
AU - D'Amico, Gianpiero
AU - Brunello, Giulia
AU - Perazzolo Marra, Martina
AU - Migliore, Federico
AU - Cacciavillani, Luisa
AU - Tarantini, Giuseppe
AU - Bauce, Barbara
AU - Iliceto, Sabino
AU - Corrado, Domenico
AU - Zorzi, Alessandro
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background A specific ECG pattern of presentation of ST-segment elevation acute myocardial infarction (STEMI), characterized by “triangular QRS-ST-T waveform” (TW), has been associated with poor in-hospital prognosis but longitudinal data on its incidence and clinical impact are lacking. We prospectively evaluated the incidence and prognostic meaning of the TW pattern in a cohort of consecutive STEMI patients. Methods All STEMI patients who presented within 12 h of symptoms onset and showed no complete bundle branch block or paced ventricular rhythm were included. The TW pattern was defined as a unique, giant wave (amplitude ≥ 1 mV) resulting from the fusion of the QRS complex, the ST-segment and the T-wave and showing a “triangular” morphology with a positive polarity in the leads exploring the ischemic region. Results Among 428 consecutive STEMI patients, 367 fulfilled the enrollment criteria. The TW pattern was identified in 5 of 367 patients (1.4%) on the admission ECG. This subset of STEMI patients with TW pattern significantly more often showed a left main coronary artery involvement (2/4, 50% vs 2/322, 0.6%; p < 0.001), experienced ventricular fibrillation (5/5, 100% vs 35/362, 9.6% p < 0.001), had cardiogenic shock (4/5, 80% vs. 14/362, 3.8%, p < 0.001) and died during hospitalization (2/5, 40% vs 15/362, 4.1% p = 0.02), compared with those with other ST-segment elevation ECG patterns. Conclusions The TW pattern is an uncommon ECG finding, which reflects the presence of a large area of transmural myocardial ischemia and predicts cardiogenic shock accounting for high in-hospital mortality. When present, this ECG pattern should prompt aggressive therapeutic strategies, including mechanical support of circulation.
AB - Background A specific ECG pattern of presentation of ST-segment elevation acute myocardial infarction (STEMI), characterized by “triangular QRS-ST-T waveform” (TW), has been associated with poor in-hospital prognosis but longitudinal data on its incidence and clinical impact are lacking. We prospectively evaluated the incidence and prognostic meaning of the TW pattern in a cohort of consecutive STEMI patients. Methods All STEMI patients who presented within 12 h of symptoms onset and showed no complete bundle branch block or paced ventricular rhythm were included. The TW pattern was defined as a unique, giant wave (amplitude ≥ 1 mV) resulting from the fusion of the QRS complex, the ST-segment and the T-wave and showing a “triangular” morphology with a positive polarity in the leads exploring the ischemic region. Results Among 428 consecutive STEMI patients, 367 fulfilled the enrollment criteria. The TW pattern was identified in 5 of 367 patients (1.4%) on the admission ECG. This subset of STEMI patients with TW pattern significantly more often showed a left main coronary artery involvement (2/4, 50% vs 2/322, 0.6%; p < 0.001), experienced ventricular fibrillation (5/5, 100% vs 35/362, 9.6% p < 0.001), had cardiogenic shock (4/5, 80% vs. 14/362, 3.8%, p < 0.001) and died during hospitalization (2/5, 40% vs 15/362, 4.1% p = 0.02), compared with those with other ST-segment elevation ECG patterns. Conclusions The TW pattern is an uncommon ECG finding, which reflects the presence of a large area of transmural myocardial ischemia and predicts cardiogenic shock accounting for high in-hospital mortality. When present, this ECG pattern should prompt aggressive therapeutic strategies, including mechanical support of circulation.
KW - Acute myocardial infarction
KW - Cardiogenic shock
KW - Electrocardiogram
KW - ST-segment
KW - Ventricular fibrillation
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U2 - 10.1016/j.jelectrocard.2017.08.023
DO - 10.1016/j.jelectrocard.2017.08.023
M3 - Article
AN - SCOPUS:85029500113
VL - 51
SP - 8
EP - 14
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
SN - 0022-0736
IS - 1
ER -