Serial Modified Selvester QRS Score Trajectories as Predictors of Left Ventricular Functional Recovery Following Primary Percutaneous Coronary Intervention in Patients with First ST-Segment Elevation Myocardial Infarction

Abstract

Objectives: This study aimed to determine whether serial Modified Selvester QRS score trajectories are associated with surrogate markers of reperfusion quality and predict left ventricular functional recovery measured by global longitudinal strain (GLS) three months after primary percutaneous coronary intervention (pPCI). Methodology: This prospective single-centre cohort study enrolled 185 consecutive patients presenting with first ST-segment elevation myocardial infarction (STEMI) who underwent guideline-directed primary PCI. Successful reperfusion was defined using a composite endpoint consisting of final TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution 90 minutes after reperfusion. Modified Selvester QRS scores were measured on admission, 18–24 hours after PCI, and at three-month follow-up. Echocardiographic assessment of GLS was performed within 24 hours following reperfusion and repeated after three months. Results: Successful reperfusion was achieved in 131 patients (70.8%). Serial Modified Selvester QRS trajectories differed significantly according to reperfusion status, with a significant time-by-reperfusion interaction (F(2,366)=19.33, P<0.001). Patients achieving successful reperfusion demonstrated stable QRS scores during the first 24 hours followed by significant improvement at three months, whereas patients with non-successful reperfusion exhibited an early increase in QRS score that remained persistently elevated throughout follow-up. Multivariable analysis identified admission Modified Selvester QRS score (β=0.245, P<0.001), corrected TIMI frame count (β=0.233, P=0.002), baseline GLS (β=0.207, P=0.001), and peak CK-MB (β=0.138, P=0.045) as independent predictors of three-month GLS. Conclusion: Serial Modified Selvester QRS score trajectories were independently associated with surrogate measures of myocardial reperfusion quality and subsequent left ventricular functional recovery following primary PCI for first STEMI.