Prognostic Value of Frontal QRS-T Angle in Predicting Survival After Primary Percutaneous Coronary Revascularization/Coronary Artery Bypass Grafting for ST Elevation Myocardial Infarction

Abstract Background Frontal QRST Angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor following STEMI remains unknown. Methods We evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy and one-year mortality. Results Out of 267 patients, 187 (70%) were males and the majority (49.4%) of patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101-180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1-50° had higher survival (85.6%) compared with FQRST=51-100° (72.3%) and FQRST=101-180° (67.9%), [log rank, p=0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31-13.50]) remained an independent predictor of one-year mortality. FQRST based risk score (1-50°=0 points, 51-100°=2 points, 101-180°=5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score [MCRS] (C statistic=0.875 [95%CI: 0.813-0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p Conclusion FQRST represents a novel independent predictor of one-year mortality in STEMI patients undergoing reperfusion. A high FQRST based risk score was associated with greater mortality and longer length of stay and, after combining with MCRS, improved discriminatory ability for one-year mortality.