Predischarge QRS score and risk for heart failure after first ST-elevation myocardial infarction

Background: The prognostic value of the QRS score, a simple index of infarct size after a first ST-elevation myocardial infarction, has not been adequately explored in the reperfusion era. Methods and Results: We prospectively followed up 100 consecutive survivors of a first ST-elevation myocardial infarction (aged 64 +/- 13 years, 77% were male) without bundle branch block or paced rhythm at hospital discharge for 3 months. The modified 32-point QRS score was calculated as part of the pre-discharge evaluation. The predefined primary endpoint was the composite of death or hospitalization for heart failure. By 3 months, 6 patients died and 16 patients were readmitted for heart failure, resulting in a 22% primary endpoint rate. Patients with a QRS score >= 3 at hospital discharge (n = 38) had significantly more events compared with those with a QRS score < 3 (44.7% vs. 8.2%, P < .001), and all six deaths occurred among patients with a QRS score >= 3 (P = .002). A QRS score < 3 reliably predicted heart-failure free survival during the follow-up period (negative predictive value 91.9%). In multivariate models, the QRS score was an independent predictor of the primary endpoint (hazard ratio = 1.4 per point, 95% confidence interval 1.1-1.8, P = .003). Conclusion: For patients surviving a first ST-elevation myocardial infarction, the predischarge QRS score provides powerful prognostic information on short-term outcomes, including mortality and readmission for heart failure.