Background: QT dispersion (QTD) is a non-invasive
echocardiographic
(ECG) marker reflecting myocardial
repolarization heterogeneity and arrhythmic risk, particularly in
ST-Elevation Myocardial Infarction (STEMI). Early reperfusion
may reduce QTD and improve outcomes. This study aims to
compare QTD before and after treatment with streptokinase (SK)
versus Primary Percutaneous Coronary Intervention (pPCI) in
STEMI patients, considering the timing of intervention.
Methods: This prospective observational study included 300
STEMI patients admitted to Banha University and El-Sheikh
Zayed Specialized Hospitals between September 2023 and April
2024. Patients were stratified into four groups: Group A1 (PCI
≤3 hours), A2 (PCI >3–12 hours), B1 (SK ≤3 hours), and B2 (SK
>3–12 hours). All cases underwent ECG, echocardiography, and
standard laboratory assessments. QTc dispersion (QTcD) was
measured before and 24 hours after reperfusion. Results: Post
treatment QTcD was substantially lower in early PCI group (A1:
21.87 ± 14.89 ms) compared to delayed PCI (A2: 28.05 ± 12.92
ms, p = 0.015), early SK (B1: 24.22 ± 18.87 ms, p = 0.001), and
delayed SK (B2: 40.56 ± 15.37 ms, p = 0.001). Group B2 also
showed the highest incidence of ventricular tachycardia (VT),
ventricular fibrillation (VF), and mortality (p < 0.05).
Multivariate analysis identified age, diabetes, anterior STEMI,
and delayed presentation as independent predictors of increased
QTD. Conclusion: Early reperfusion, particularly via pPCI, is
correlated with lower QTD and better clinical outcomes. Delayed
treatment and underlying risk factors increase arrhythmic risk,
underscoring the need for timely intervention in STEMI patients. |
