Author + information
- Doron Zahger, MD* ( and )
- Arik Wolak, MD
- ↵*Department of Cardiology, Soroka University Medical Center, P. O. Box 151, Beer Sheva 84101, Israel
We read with great interest the excellent review by Niccoli et al. (1) about the no-reflow phenomenon in humans. In their paper, the authors describe various techniques for the prediction of no-reflow. As far as electrocardiography is concerned, the authors only mention the QRS score as a predictor of ischemia-related injury.
The extent of terminal QRS distortion on the admission electrocardiogram, known as the grade of ischemia, is a strong predictor of failure of ST-segment resolution as well as of angiographic no-reflow and infarct size. We have shown both in patients receiving thrombolytic therapy (2) and in patients undergoing primary percutaneous intervention (3) that grade 3 ischemia is the strongest independent predictor available on admission for the no-reflow phenomenon. Because electrocardiography is the most widely available and least expensive tool at our disposal, and because this simple parameter is a robust predictor of no-reflow, we believe that it should be widely used to predict the risk of no-reflow and possibly to select patients for protective therapies.
- American College of Cardiology Foundation