Miyokard İnfarktüsü Geçiren Hastalarda Koroner Anjiyografi Öncesi ve Sonrası QT Değişimi
Abstract
EKG, göğüs ağrısıyla başvuran hastaların acil serviste değerlendirilmesinde hızlı, düşük maliyetli, kolay erişilebilir ve tekrarlanabilir bir tanı yöntemidir. Bu çalışmanın amacı, MI tanısı alan hastalarda, acil serviste çekilen EKG'lerde gözlenen QTc aralığı uzaması, ST segment depresyonu, T dalga negatiflikleri ve elektriksel aks değişikliklerinin, hastaların klinik seyri ve koroner anjiyografi sonuçlarıyla ilişkisini araştırmaktır. Ayrıca bu değişikliklerin uygulanan tedavi yöntemleri (medikal tedavi veya perkütan koroner girişim) ile olan ilişkisi değerlendirilmiştir. Yöntem: Bu araştırmaya, 20/05/2024–20/05/2025 tarihleri arasında Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, Acil Servis Polikliniğinde miyokard infarktüsü tanısı alan ve takibi yapılan, yaşları 18-100 yaş arasındaki hastalar dahil edildi. Hastaların yaş, cinsiyet, tanı bilgileri, kullanılan ilaçları ve EKG bulguları; hemşire gözlem formları, hasta dosyaları ve hastane veri kayıt sisteminden elde edilerek değerlendirildi. Tüm hastaların acil servise başvuru sırasında çekilen ilk ve ikinci EKG'leri ile PCI sonrasında elde edilen EKG'ler incelendi. QTc süresi, kalp elektriksel aksı, ST segment depresyonu ve T dalgası negatiflikleri ölçüldü. PCI öncesi ve sonrası veriler karşılaştırılarak QTc değişimi, aks kaymaları, ST segment değişiklikleri ve T dalga negatiflikleri arasındaki farklılıklar analiz edildi. Bulgular: Çalışmaya 109 hasta dahil edildi. Hastaların %69,7 'si (n= 76) erkek, %30,3 'ü (n=33) kadındı. Hastaların yaş ortalaması 62±10,68 olarak hesaplandı. Hastaların çekilen EKG'lerinde PCI sonrasına göre QTc'de uzama vardı ve çalışmamızda tanı sırasındaki QTc ile PCI sonrası QTc arasında anlamlı farklılık vardı. T dalga negatifliğinde de anlamlı farklılık saptanmasına rağmen ST depresyonunda anlamlı farklılık saptanmadı. Hastaların %40,4'ünün aksı sola doğru sapmıştı ve hastaların %52,3'ünün ise sağa doğru saptığı tespit edildi. Hastaların PCI sonrasına göre aks değişimi anlamlı idi. LMCA, LAD veya Cx lezyonlarında aksın genellikle sola; RCA veya eşlik eden damar tutulumu olan olgularda ise sağa deviye olduğu gözlemlendi. Ancak tedavi yöntemi ile aks değişikliği arasında anlamlı bir fark saptanmadı. Tedavi yöntemine göre QTc karşılaştırıldığında, medikal tedavi grubunda anlamlı değişim saptanmazken, anjiyo uygulanan hastalarda QTc değerlerinde düşüş gözlemlennmiş ancak anlamlı bulunmamıştır (p=0,086). Post anjiyo T negatifliği ile tedavi yöntemi karşılaştırıldığında anlamlı bir fark elde edilmiştir. Tedavi türlerine göre en sık PCI uygulanan damar RCA (%26,6), ardından Cx (%23,9) ve LAD (%22,9) olmuştur. Hastaların %20,2'sine ciddi damar tıkanıklığı saptanmadığından medikal tedavi uygulanmıştır. Sonuç: Bu çalışmada hastaların tanı sırasındaki QTc ile PCI sonrası QTc arasında anlamlı farklılık olduğu tespit edilmiştir. Damar tıkanıklığı tespit edilen hastalarda, tıkanıklık saptanmayan ve anjiyografi sonrası medikal tedavi verilen hastalara kıyasla QTc aralığında uzama gözlemlenmiştir. Ayrıca, kalbin aksı işlem yapılan damar RCA ise sağa doğru kaydığı LAD ve/veya CX ise aksın sola doğru deviye olduğu saptanmış. T dalga negatifliği, QTc aralığı ve elektriksel aks takibi, hastalarda hem tedavi yanıtının değerlendirilmesinde hem de prognozun öngörülmesinde önemli bilgiler sunabilir. Özellikle yaşlı, diyabetik ya da atipik semptomlarla başvuran hastalarda bu EKG parametreleri, erken karar alma ve hızlı yönlendirme süreçlerinde destekleyici bir araç olarak kullanılabilir. Acil serviste hasta sirkülasyonunun hızlandırılması, koroner yoğun bakıma yatış ve anjiyografi ünitesine ulaşım süresinin kısaltılması büyük önem taşımaktadır. Kalp krizi, kompleks ve dinamik bir süreç olduğundan, erken reperfüzyon sağlayacak girişimlerin uygulanabilmesi için PCI adaylarının zamanında belirlenmesi gereklidir. Bu nedenle, invaziv olmayan tanı yöntemlerinin daha yaygın ve etkin bir şekilde kullanımı teşvik edilmelidir.
ECG is a rapid, low-cost, easily accessible, and reproducible diagnostic method for the evaluation of patients presenting with chest pain in the emergency department. The aim of this study was to investigate the relation of QTc interval prolongation, ST segment depression, T wave negativity and electrical axis changes observed in ECGs taken in the emergency department with the clinical course and coronary angiography results in patients with MI. In addition, the relationship between these changes and the treatment modalities (medical therapy or percutaneous coronary intervention) was evaluated. Method: Patients aged between 18 and 100 years who were diagnosed with myocardial infarction and followed up in the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between 20/05/2024 and 20/05/2025 were included in this study. Age, gender, diagnostic information, medications used and ECG findings of the patients were obtained from nurse observation forms, patient files and hospital data recording system. The first and second ECGs of all patients on admission to the emergency department and ECGs obtained after PCI were analyzed. QTc duration, cardiac electrical axis, ST segment depression and T wave negativity were measured. Pre- and post-PCI data were compared and differences in QTc change, axis shifts, ST segment changes and T wave negativity were analyzed. Results: The study included 109 patients. 69.7% (n=76) of the patients were male and 30.3% (n=33) were female. The mean age of the patients was 62±10.68 years. There was a prolongation of QTc in the ECGs of the patients from pre- to post-angiography and there was a significant difference between QTc at diagnosis and QTc after PCI in our study. Although there was a significant difference in T wave negativity, there was no significant difference in ST depression. The axis of 40.4% of the patients was deviated to the left and 52.3% of the patients were deviated to the right. The axis change was significant in pre-angiography compared to post-angiography. In patients with LMCA, LAD or Cx lesions, the axis usually deviated to the left; in patients with RCA or concomitant vessel involvement, the axis deviated to the right. However, there was no significant difference between treatment modality and axis changes. When QTc was compared according to treatment modality, no significant change was found in the medical treatment group, while a decrease in QTc values was observed in patients who underwent angioplasty, but it was not significant (p=0.086). A significant difference was obtained when T negativity at post angiography was compared with the treatment modality. According to treatment modality, the most common vessel to undergo PCI was RCA (26.6%), followed by Cx (23.9%) and LAD (22.9%). Medical treatment was administered to 20.2% of the patients because severe vessel occlusion was not detected. Conclusion: In this study, a significant difference was found between QTc at diagnosis and QTc after PCI. A prolongation of the QTc interval was observed in patients in whom vessel occlusion was detected compared to patients in whom occlusion was not detected and who received medical treatment after angiography. In addition, the axis of the heart shifted to the right if the treated vessel was RCA and deviated to the left if it was LAD and/or CX. T wave negativity, QTc interval and electrical axis monitoring may provide important information in the evaluation of treatment response and prediction of prognosis in patients. Especially in elderly patients, diabetic patients or patients presenting with atypical symptoms, these ECG parameters can be used as a supportive tool in early decision making and rapid guidance processes. It is of great importance to accelerate patient circulation in the emergency department and to shorten the time of admission to the coronary intensive care unit and transportation to the angiography unit. Since heart attack is a complex and dynamic process, timely identification of PCI candidates is essential for early reperfusion interventions. Therefore, more widespread and effective use of non-invasive diagnostic methods should be encouraged.
ECG is a rapid, low-cost, easily accessible, and reproducible diagnostic method for the evaluation of patients presenting with chest pain in the emergency department. The aim of this study was to investigate the relation of QTc interval prolongation, ST segment depression, T wave negativity and electrical axis changes observed in ECGs taken in the emergency department with the clinical course and coronary angiography results in patients with MI. In addition, the relationship between these changes and the treatment modalities (medical therapy or percutaneous coronary intervention) was evaluated. Method: Patients aged between 18 and 100 years who were diagnosed with myocardial infarction and followed up in the Emergency Department of Van Yüzüncü Yıl University Faculty of Medicine between 20/05/2024 and 20/05/2025 were included in this study. Age, gender, diagnostic information, medications used and ECG findings of the patients were obtained from nurse observation forms, patient files and hospital data recording system. The first and second ECGs of all patients on admission to the emergency department and ECGs obtained after PCI were analyzed. QTc duration, cardiac electrical axis, ST segment depression and T wave negativity were measured. Pre- and post-PCI data were compared and differences in QTc change, axis shifts, ST segment changes and T wave negativity were analyzed. Results: The study included 109 patients. 69.7% (n=76) of the patients were male and 30.3% (n=33) were female. The mean age of the patients was 62±10.68 years. There was a prolongation of QTc in the ECGs of the patients from pre- to post-angiography and there was a significant difference between QTc at diagnosis and QTc after PCI in our study. Although there was a significant difference in T wave negativity, there was no significant difference in ST depression. The axis of 40.4% of the patients was deviated to the left and 52.3% of the patients were deviated to the right. The axis change was significant in pre-angiography compared to post-angiography. In patients with LMCA, LAD or Cx lesions, the axis usually deviated to the left; in patients with RCA or concomitant vessel involvement, the axis deviated to the right. However, there was no significant difference between treatment modality and axis changes. When QTc was compared according to treatment modality, no significant change was found in the medical treatment group, while a decrease in QTc values was observed in patients who underwent angioplasty, but it was not significant (p=0.086). A significant difference was obtained when T negativity at post angiography was compared with the treatment modality. According to treatment modality, the most common vessel to undergo PCI was RCA (26.6%), followed by Cx (23.9%) and LAD (22.9%). Medical treatment was administered to 20.2% of the patients because severe vessel occlusion was not detected. Conclusion: In this study, a significant difference was found between QTc at diagnosis and QTc after PCI. A prolongation of the QTc interval was observed in patients in whom vessel occlusion was detected compared to patients in whom occlusion was not detected and who received medical treatment after angiography. In addition, the axis of the heart shifted to the right if the treated vessel was RCA and deviated to the left if it was LAD and/or CX. T wave negativity, QTc interval and electrical axis monitoring may provide important information in the evaluation of treatment response and prediction of prognosis in patients. Especially in elderly patients, diabetic patients or patients presenting with atypical symptoms, these ECG parameters can be used as a supportive tool in early decision making and rapid guidance processes. It is of great importance to accelerate patient circulation in the emergency department and to shorten the time of admission to the coronary intensive care unit and transportation to the angiography unit. Since heart attack is a complex and dynamic process, timely identification of PCI candidates is essential for early reperfusion interventions. Therefore, more widespread and effective use of non-invasive diagnostic methods should be encouraged.
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Acil Tıp, Emergency Medicine
Turkish CoHE Thesis Center URL
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