R wave peak time and no reflow following primary percutaneous coronary intervention: Immediate and short-term outcomes

Atherosclerotic cardiovascular diseases, especially ST elevation myocardial infarction (STEMI) is the leading cause ofmorbidity and mortality worldwide. Primary percutaneous coronary intervention (PCI) remains the gold standard treatment of STEMI for restoration of coronary blood flow. Despite achieving vessel patency in about 95% of the cases, coronary No reflow (NR) remains the bottleneck of primary PCI [ [1]]. NR occurs in 11–41% of STEMI patients treated by primary PCI. [ [2,3]]. Many mechanisms have been hypothesized to explain this phenomenon, including ischemic endothelial injury that obstructs the capillary lumen, neutrophil accumulation, reactive oxygen species and distal embolization of atherothrombotic debris [ [3,4]]. In practice, the most preferred methods to define NR are thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), myocardial blush grade (MBG), and ST-segment resolution (STR) [ [[5], [6], [7]]]. Angiographic NR has been defined as TIMI flow grade<3 or TIMI grade 3 with MBG<2 [ [8]]. Early prediction, prompt diagnosis, and subsequent intervention by means of pharmacological and mechanical options are of paramount importance, since coronary NR is associated with adverse clinical events including death, malignant arrhythmias, and heart failure [ [9]].

Electrocardiography (ECG) is a simple, non-invasive and readily available tool in routine practice for diagnosis and management of STEMI. However, there are only very few ECG parameters available to assess myocardial reperfusion following primary PCI.

R wave peak time (RWPT) was described as early as 1930 by Macleod et al. [ [10]] as duration from onset of QRS to peak of R wave. It found many clinical applications subsequently including identification of ventricular hypertrophy, volume overload, conduction abnormalities, and differentiation of wide QRS complex tachycardia [ [[11], [12], [13]]]. RWPT is a dynamic parameter which mainly localises ischaemic myocardium at risk, when measured in infarct related artery (IRA) leads.

So, the present study was undertaken to assess the baseline RWPT along with RWPT post angioplasty and its association with NR. The rationale was to test that whether preprocedural RWPT could predict NR and assessment of RWPT duration in post intervention patients will predict improved or persistent NR. We also planned to conduct a proper clinical follow-up of at least 6 months duration in our study.

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