Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction

• Main Authors: Christina Tiller, Martin Reindl, Sebastian Johannes Reinstadler, Magdalena Holzknecht, Michael Schreinlechner, Alexander Peherstorfer, Nicolas Hein, Ivan Lechner, Agnes Mayr, Gert Klug, Bernhard Metzler
• Format: Article
• Language: English
• Published: BMC 2019-12-01
• Series: BMC Cardiovascular Disorders
• Subjects: ST-segment elevation myocardial infarction; Electrocardiography; Cardiac magnetic resonance imaging; Risk stratification
• Online Access: https://doi.org/10.1186/s12872-019-1230-0

Abstract Background Complete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI. Methods In this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1–4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO). Results Complete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81. Conclusions In reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.