P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow

Objectives Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PW_DIS respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PW_DIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. Method Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PW_DIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. Results Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPT_D2) and V1 (PWPT_V1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPT_D2 was found to be an independent predictor of NR development. Conclusion In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development.