(2020-2021) Modified Selvester QRS Score in Predicting Successful Resolution of ST Segment Elevation in Patients with Acute Myocardial Infarction receiving Thrombolytic Therapy with Streptokinase.

BACKGROUND: Cardiovascular illnesses are a major cause of death for people and are a growing burden on society. We also observed a radical shift from conservative strategies of bed rest to re perfusion strategies of thrombolysis and PCI directed therapies. The main aim of this reperfusion strategies are to restore the coronary blood flow and achieve myocardial perfusion. This can be detected by the early and complete resolution of ST segment elevation after treatment. So, this makes it extremely important to predict the ST segment resolution with thrombolysis before initiating treatment. This modified Selvester score is one such score which helps us in this aspect. AIM OF THE STUDY: To determine whether modified Selvester QRS scoring system would predict the resolution of ST segment elevation in patients with acute myocardial infarction receiving thrombolytic therapy with streptokinase. MATERIALS AND METHODS: This study was conducted in Government Chengalpattu medical college with study population of 61. Information gathered about the patient’s type of MI, Fasting lipid profile, Diabetes, Hypertension. Baseline ECG was taken and QRS score was calculated with the initial ECG and 90 minutes ECG after thrombolysis was taken. STE (ST Elevation) in initial ECG taken as STE1 and 90 minutes after thrombolysis taken as STE2 and the difference between the two taken as ST segment resolution (STR). The patients are divided into resolution (STR more than or equal to 50%) and non resolution group (STR less than 50%) group. Based on the value QRS <4 predicting the resolution group and other characteristics are studied. RESULTS: The mean age of the whole group is 56.07 ±11.845 with 43 being male (70%) and 18 (30%) being female and older individuals are seen more in the non- resolution group than the resolution group and QRS score is high in the older age which shows as the age advances the chance of non-resolution. Sex, Smoking, Alcohol, Hypertension shows no statistical relation with respect to ST resolution and QRS score respectively. However, Diabetics (50% in the study) showed a significant relation to QRS score and had a high QRS score but they did not show any correlation with the ST resolution. Cardiac Failure has a significant correlation with respect to QRS score and ST resolution. The patients with cardiac failure have a high QRS score (69% of patients) and there was ST non resolution in 74% of patients. The patients with the type of MI or Dyslipidemia did not have any significance in this study. There was also a negative correlation between Ejection fraction and QRS score. CONCLUSION: Our study concluded that high QRS score noted with increasing age, diabetics, cardiac failure and have a more risk of non resolution. Also a significant negative corelation observed between EF and QRS score is noted. Thus, QRS score would reliably predict the ST segment resolution in patients with STEMI receiving thrombolytic therapy. QRS score >4 says the patient has higher chances of ST non resolution