Defective recovery of QT dispersion due to no-reflow following acute interventional therapy in patients with ST-segment elevation myocardial infarction

Abstract

Background: Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).

Methods: A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.

Results: In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 vs. 73±22 ms; P=0.009) and QTcd (54±19 vs. 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 vs. 75±23 ms; P=0.58) or QTd (70±22 vs. 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% vs. 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).

Conclusions: The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.

Keywords: QT dispersion (QTd); ST-segment elevation myocardial infarction (STEMI); no-reflow (NR); percutaneous coronary intervention (PCI); ventricular arrhythmias events.

Figure 1

Flowchart of participant inclusion. NR, no-reflow.

Figure 2

Comparison of post- and preprocedure QTd. Postprocedure QTd in the non-NR group significantly decreased from baseline (P=0.009). The postprocedure QTd was higher in the NR group than in the non-NR group (P=0.03). QTd, QT dispersion; NR, no-reflow.

Figure 3

Comparison of post- and preprocedure QTcd. The postprocedure QTcd in the non-NR group was significantly decreased from baseline (P=0.01). The postprocedure QTcd was higher in the NR group than in the non-NR group (P=0.03). QTcd, corrected QT dispersion; NR, no-reflow.

Figure 4

Comparison of the ΔQTd-R and ΔQTcd-R between the NR group and non-NR group. The ΔQTd-R and ΔQTcd-R values were higher in the NR group than in the non-NR group (P<0.05). NR, no-reflow; QTd, QT dispersion; ΔQTd-R, the relative reduction of pre- and post-procedural 12 hours on QTd. ΔQTcd-R, the relative reduction of pre- and post-procedural 12 hours on QTcd.

Figure 5

Diagram illustrating the patient follow-up process. NR, no-reflow.

Figure 6

Changes in QTd at follow-up in the NR group. NR, no-reflow; QTd, QT dispersion.