الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Primary percutaneous coronary intervention (PCI) as a type of
coronary reperfusion therapy that leads to recanalization and improved
myocardial reperfusion in patients with ST elevation myocardial
infarction (STEMI) (1, 2)
.
A routine 12-lead ECG is recognized as a gold standard for the
rapid diagnosis of STEMI (3). Myocardial infarction and assessment of the
reperfusion may be recognized through dynamic changes in standard
ECG, which include pathological Q-wave, hyper acute T-wave, and STsegment elevation. Several previous studies have reported a positive
relationship of QRS score evaluated at discharge (when the acute infarct
process had finished) with Mortality) (5, 168)
.
QRS scoring based on ECGs is a simple method and takes minutes
to be done and by it we will predict complication and comorbidities at
admission as no reflow, LV scar, impairment of left ventricular function.
This prediction will make us deal with and prepare earlier to pass and
decrease the predicted complication and careful follow up to these
patients.
MI is defined in pathology as myocardial cell death due to
prolonged ischemia. After the onset of myocardial ischemia, histological
cell death is not immediate, but takes a period to develop as little as 20
min, or less in some animal models. It takes several hours before
myocardial necrosis can be identified by macroscopic or microscopic
post-mortem examination. Complete necrosis of myocardial cells at risk
requires at least 2-4h, or longer, depending on the presence of collateral
circulation to the ischemic zone, persistent or intermittent coronary
arterial occlusion, the sensitivity of the myocytes to ischemia, pre-conditioning, and individual demand for oxygen and nutrients. The entire
process leading to a healed infarction usually takes at least 5-6 weeks and
reperfusion may alter the macroscopic and microscopic appearance (6). Myocardial injury is detected when blood levels of sensitive and specific
biomarkers such as MB fraction of creatine kinase (CKMB) are increased (7)
.
The QRS score has been updated and amended multiple times
since its original description in 1972 (194)
. The most recent changes came
in 2009 with a publication describing how to apply the QRS score in the
setting of hypertrophy and conduction defects (90).