The Value of Simplified Selvester QRS Scoring System in Predicting ST-segment Resolution after Thrombolysis in Patients with Acute Myocardial Infarction

10.5083/ejcm.20424884.108 , Cite or Link Using DOI
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Samad Ghaffari MD, Babak Kazemi MD, Gholamreza Saeidi MD, Nariman Sepehrvand M.D, Leili Pourafkari MD


Background: Selvester QRS scoring system was developed for estimating the infarct size from the electrocardiogram (ECG).

Objective: To evaluate the predictive value of the simplified version of this scoring system on ST-segment resolution (STR) mortality in patients with acute ST-elevation myocardial infarction (STEMI) undergoing thrombolytic therapy (TLT).

Methods: We enrolled 100 consecutive patients with their first acute STEMI within 12 hours of onset of chest pain who were candidates for TLT. The Selvester QRS score was estimated on the first admission ECG. Sum of ST-segment elevation amount in millimeters was measured immediately before and 90 minutes after TLT. The difference between these two was measured and expressed as sum of STR (sSTR). All subjects were categorized into two groups: those with sSTR≥ 50% and others with sSTR<50%.

Results: Mean Selvester QRS score was significantly lower in the sSTR≥ 50% vs. sSTR<50% group (2.62±1.50 vs. 8.02±2.96; p= 0.001). Using a cutoff value of ≥3.5 points, the Selvester score had a sensitivity of 81%, specificity of 70%, PPV of 81% and NPV of 70% in predicting sSTR< 50%. Those with anterior STEMIs had larger scores (p< 0.0001) and showed more no-reflow than inferior STEMIs (p= 0.001). Low left ventricular function was associated with higher QRS scores (p= 0.02). During a mean follow up period of about 13±1.7 months, 18.6% of patients with a Selvester score ≥3.5 died compared to 4.4% in the other group (p=0.03).

Conclusion: The Selvester QRS score with ≥3.5 points on admission ECG predicts incomplete STR after TLT. These patients experience higher mortality during one year follow up.