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Relationship of QRS duration at baseline and changes over 60 minutes after fibrinolysis to 30-day mortality with different locations of ST elevation myocardial infarction: Results from the HERO-2 trial
  1. Cheuk-Kit Wong (cheuk-kit.wong{at}otagodhb.govt.nz)
  1. Dunedin School of Medicine, University of Otago, New Zealand
    1. Wanzhen Gao (wanzhen.gao{at}aut.ac.nz)
    1. Akoranga Campus, Auckland University of Technology, New Zealand
      1. Ralph A H Stewart (rstewart{at}adhb.govt.nz)
      1. Auckland City Hospital; Green Lane Cardiovascular Services, New Zealand
        1. John K French (j.french{at}unsw.edu.au)
        1. Department of Cardiology, Liverpool Hospital, Sydney, Australia
          1. Philip E G Aylward (p.aylward{at}flinders.edu.au)
          1. Flinders Medical Centre, Flinders Drive, Australia
            1. Harvey D White (harveyw{at}adhb.govt.nz)
            1. Auckland City Hospital; Green Lane Cardiovascular Services, New Zealand

              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 randomization and at 60 minutes after fibrinolytic therapy.

              Patients: 12,456 patients with normal conduction at both randomization and 60-minutes time points and 510 with RBBB at both time points.

              Main outcome measure: 30-days mortality.

              Results: On the baseline ECG, there was a positive association between QRS duration and 30-day mortality with anterior 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 msec 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 wave. The association was not present for inferior AMI. Changes in QRS duration over 60 minutes 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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