Vol 25, No 5 (2018)
Original articles — Clinical cardiology
Published online: 2018-03-29

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Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction

Janosch Cupa1, Ivo Strebel1, Patrick Badertscher1, Roger Abächerli1, Raphael Twerenbold1, Lukas Schumacher1, Jasper Boeddinghaus1, Thomas Nestelberger1, Patrick Maechler1, Nikola Kozhuharov1, Maria Rubini Giménez1, Karin Wildi1, Jeanne du Fay de Lavallaz1, Zaid Sabti1, Lorraine Sazgary1, Christian Puelacher1, Deborah Mueller1, Chiara Bianci1, Òscar Miró2, Carolina Fuenzalida2, Sofia Calderón2, F. Javier Martín-Sánchez3, Sergio Lopez Iglesias3, Beata Morawiec4, Damian Kawecki4, Jiri Parenica5, Dagmar I. Keller6, Nicolas Geigy7, Stefan Osswald1, Christian Mueller1, Tobias Reichlin1
Pubmed: 29611166
Cardiol J 2018;25(5):601-610.


Background: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.

Methods: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.

Results: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88–108] vs. 94 ms [IQR 86–102] and 436 ms [IQR 414–462] vs. 425 ms [IQR 407–445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.

Conclusions: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

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