Association between QTd, Tp-e/QT Ratio and In-hospital Prognosis in Thrombolysed Acute ST-elevation Myocardial Elevation (STEMI) Patients.

Background: Both QTd and Tp-e/QT ratio have been linked to increased risk for arrhythmia and mortality. But Significance of QTd in STEMI Patients is not documented in all studies and Tp-e/QT ratio is a novel index which is understudied in these patients. Therefore, the present study is aimed to determine the short term, in-hospital prognostic value of QTd and Tp-e/QT ratio in thrombolysed STEMI patients.

Methods: This is a prospective, observational study that includes 321 patients. Relevant clinical data is collected. QTd and Tp-e/QT ratio (tangent method) is calculated from "at admission ECG" just before thrombolysis. Multivariate logistic regression analysis was done to determine the predictors of in-hospital outcomes. A p-value of >0.05 is considered statistically significant.

Results: The mean age of study population was 56.72 ± 11.36 with males:females ratio of 2.73:1. Mean value of QTd and Tp-e/QT ratio were 80.29 ±10.2 ms and 0.28 ± 0.05 respectively. The QTd and Tp-e/QT ratio are found to be independent predictors of in MACE, in addition to absence of beta-blocker therapy at admission, AWMI. Tp-e/QT ratio is independent predictor of in-hospital mortality in addition to reduced LVEF and AWMI. Analysis of the ROC curve demonstrated that the optimal cut-off value for in-hospital outcomes was a Tp-e/QT ratio of ≥0.30.

Conclusion: Both QTd and Tp-e/QT ratio may serve as a prognostic predictors of in hospital MACE independently but only Tp-e/QT ratio predicts patients with in-hospital all cause mortality in thrombolysed STEMI patients.