Evaluation of Cardio Electrophysiologic Balance Index in Myocardial Infarction with ST Segment Elevation

Evaluation of Cardio Electrophysiologic Balance Index in Myocardial Infarction with ST Segment Elevation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Cardio Electrophysiologic Balance Index in Myocardial Infarction with ST Segment Elevation Önder Demiröz, Ersin Yıldırım, Behzat Özdemir, Bayram Bağırtan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6584125/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Index of cardio electrophysiologic balance (iCEB) obtained from ECG (electrocardiogram) is used as a potential estimator of ventricular fibrillation (VF) in various clinical conditions. However, this index has not been evaluated in ST segment elevation myocardial infarction (STEMI). This paper evaluates basal iCEB values in STEMI patients and its potential for estimating VF development. Methods 173 patients with STEMI, including 132, who were stable and 41 patients with VF in acute setting were scanned retrospectively. After assessment of demographic variables and medical history, acute presentation ECGs were evaluated for iCEB. Values obtained from stable STEMI group were recorded and compared to the results of previous studies with known control group values. In addition, VF + and - groups were also compared by iCEB results. Results 39 out of 173 patients (22.5%) were female. Median age was 58 and 54 for VF (-) and (+) groups respectively. iCEB in electrically stable STEMI patients was similar or slightly increased than general population with a mean of 4.56±0.79. VF (+) group had more chronic renal disease (9.8% vs. 2.3%, p = 0.034). Angiography results showed CX was less likely identified as the culprit lesion in VF (+) group (2.4% vs. 16.7%, p = 0.040). iCEB measurements were found similar between groups (4.56±0.79 vs. 4.60±0.90, p = 0.749). Conclusions In this study, we observed that iCEB values of stable STEMI patients were similar to previous studies, establishing an iCEB base for the STEMI population. Additionally, VF development is not linked to iCEB, therefore cannot be used as a predictor in emergency setting. ST elevation myocardial infarction index of cardio electrophysiological balance QT interval QRS duration Ventricular fibrillation Background Risk stratification in sudden cardiac death due to ventricular arrhythmias is a challenging task for clinicians who work in emergency wards, intensive care units or cardiology departments. Ventricular arrhythmias are one of the main causes of death in hereditary or acquired heart diseases and drug intoxications. Prolonged QT is long used as a classic biomarker for torsades de pointes (TdP) associated ventricular arrhythmias in the context of long QT, but it is not seen valuable in nontorsadogenic VT/VF (Ventricular tachycardia/ventricular fibrillation), and thus new parameters combining repolarization and conduction times are needed ( 1 ). Index of cardio electrophysiological balance (iCEB) is first introduced in rabbit models for predicting drug caused ventricular arrhythmias by Lu et al. ( 2 ). It is introduced as a derivative of cardiac wavelength λ and calculated as dividing QT duration by QRS duration in a dimensionless fashion. Increasing the cardiac wavelength results in TdP and the opposite action causes non TdP ventricular arrhythmias ( 3 ). These parameters were studied in patients with a variety of disorders such as hypertrophic cardiomyopathy ( 4 ), end stage renal disease (ESRD) ( 5 ), coronary slow flow and chronic coronary syndrome ( 6 , 7 ). An ESC statement paper on novel electrocardiographic indices in 2017 stated that iCEB (as classified under combined depolarization-repolarization indices) has value in predicting arrythmic occurences under dofetilide, digoxin, isoprenaline and long QT syndromes (LQTS), Brugada syndrome. Other than iCEB, there are several parameters of conduction-repolarization. QRSDx(Tp-e)/QRSd and QRSDx(Tp-e)/QRSdxQT are studied ( 8 ). The relationship of this index with ST segment elevation myocardial infarction (STEMI) has not yet been studied. The primary aim of our study is to form a baseline of iCEB measurements of STEMI patients. The secondary purpose is to assess whether increased or decreased iCEB is associated with increased incidence of ventricular fibrillation in ST elevation MI patients. Methods Study Design and Population Our study has a retrospective design. Following ethics committee approval, patient database from a training and research hospital in Turkey was scanned for STEMI patients who were followed between January 2021 and January 2023. All of this study’s creation processes were in compliance with Helsinki Declaration. After evaluation of 976 patient files, 132 STEMI patients who did not have VF were randomly selected from database as the electrically stable group. 41 cases were identified as having experienced ventricular fibrillation in emergency room or during transfer before coronary intervention. Patients who had been on medications that alter QT time, antiarrhythmic drugs, who had a history of hypertrophic cardiomyopathy, long or short QT syndrome diagnosis, symptomatic arrhythmias, syncope/sudden cardiac death survival and end stage renal disease were excluded from the study to isolate the sole effect of MI on iCEB values as much as possible. The clinical and demographic characteristics of the patients were collected from the hospital records. Complete blood count (CBC) and biochemical tests had been performed using a Beckman Coulter LH-750 and a Beckman Coulter L×20 respectively, and the results of each patient were also retrieved. The files of the patients were gathered from hospital archives and the first ECGs from emergency room/ambulance records were evaluated with the same standardized ECG ruler for measuring heart rate, QT, QTc, QRS duration, QRS dispersion, determining MI localization and iCEB. Since the study was retrospective in nature, the time interval between the onset of chest pain to the emergency ECG could not be obtained due to the heterogeneity of digital hospital records. Statistical Analysis Statistical analysis was performed using SPSS 22 for Windows Evaluation Version statistical package. Distributions of continuous variables were evaluated using the Kolmogorov-Smirnov test. Continuous variables were presented as mean ± standard deviation or median (with 25th and 75th percentiles) according to their distribution patterns. Categorical variables were summarized as frequencies and their corresponding percentages. Differences between the two groups were determined by independent samples t-test or Mann–Whitney U test for continuous variables. Categorical variables were compared by chi-square or Fisher’s exact test for two choice and Phi and Cramer’s V test for multichoice categorical variables. A p level of < 0.05 was accepted as statistically significant with 95% confidence interval and 5% margin of error, all of the results were given from two tailed tests. Results Median age was 54.00 (49.00–64.00) and 58.00 (48.00–65.00) for VF + and stable groups, respectively ( P = 0.987). There were no differences between groups in terms of female sex (12.2% vs. 25.8%; P = 0.069) and previous medical history. Chronic renal disease was significantly more frequent in VF + group (9.8% vs. 2.3%; P = 0.034). There were no other differences in terms of medication history. Demographic and baseline medical comparison between the groups are given in Table 1 . Table 1 Demographic Parameters and Medical Features of the Patients Variables VF (-) (n = 132) VF (+) (n = 41) P Age (years) 58.00(48.00–65.00) 54.00(49.00–64.00) 0.987 Female sex (%) 34(25.8%) 5(12.2%) 0.069 Medical history Syncope 0 0 - Cardiac arrest 0 0 - Atrial arrhythmia 0 0 - EPS 0 0 - CAD 23(17.4%) 6(14.6%) 0.676 DM 34(25.8%) 9(22.0%) 0.622 Hypertension 28(21.2%) 13(31.7%) 0.167 Hyperlipidemia 6(4.5%) 0 0.165 Renal disease 3(2.3%) 4(9.8%) 0.034 COPD 8(6.1%) 2(4.9%) 0.777 Cancer 3(2.3%) 0 0.330 Smoking 46(34.8%) 11(26.8%) 0.520 Antiplatelet drug use 19(14.4%) 6(14.6%) 0.970 Beta blocker use 12(9.0%) 4(9.8%) 0.763 ACEinh/ARB use 9(6.8%) 4(9.8%) 0.533 Antiischaemic drug use 0 1(2.4%) N/A MRA use 0 1(2.4%) N/A OAD/insulin use 20(15.2%) 4(9.8%) 0.383 Statin use 6(4.5%) 0 0.165 Categorical variables are given as number (percentage). Continuous variables are given as median (25th -75th percentiles) Comparisons are made with chi-square and Mann Whitney-U tests for categorical and continuous variables respectively. P < 0.05 is considered statistically significant. Patients among both groups came to the emergency room predominantly with the complaint of chest pain (93.2% vs. 80.5% for stable and VF + groups, respectively. Out of hospital cardiac arrest with documented VF was the presentation of 6 patients (14.6%) in VF + group. Vitals which include systolic and diastolic blood pressures, heart rate and peripheral oxygen saturation were similar across the groups. In terms of hemogram, renal and hepatic function tests, lipid profile and troponin levels, results were also similar. Ejection fraction (EF) of every patient was obtained by transthoracic echocardiography (TTE) right before or the day after coronary intervention. EF measurements showed no difference (median 37.5 for VF + vs. 45 for stable group; P = 0.107). After coronary imaging, it was shown that left anterior descending artery (LAD) was the most frequently encountered culprit lesion in both groups. While VF + group was more prone to LAD thrombosis than stable group, less likely to have a CX culprit (LAD thrombosis in 43.2% of stable group vs. 56.1% VF + group and CX thrombosis in 16.7% of stable vs. 2.1% of VF + group; P = 0.040). Other than culprit lesions, there were not any significant differences between the groups in terms of number of affected vessels, blood flow quality or thrombus burden after PCI. The laboratory, echocardiographic parameters and angiographic information is given in Table 2 . Table 2 Vital, Clinical and Laboratory Parameters Variables VF (-) (n = 132) VF (+) (n = 41) P Presenting symptom Chest pain: 123(93.2%) Syncope: 6(4.5%) Disturbed general condition: 3(2.3%) Chest pain: 33(80.5%) Cardiac arrest: 6(14.6%) Syncope:2(4.9%) < 0.001 Clinical subtype Anterior MI: 57(43.2%) Inferior/posterior/right MI: 72(54.5%) Lateral MI: 3(2.3%) Anterior MI: 22(53.7%) Inferior/posterior/right MI: 19(46.3%) 0.353 Systolic blood pressure 134.80±25.03 130.39±26.47 0.333 Diastolic blood pressure 83.00(62.00-102.00) 85.00(68.50–95.00) 0.803 Heart rate 82.32±24.52 89.83±20.69 0.078 Oxygen saturation 98.00(95.50–98.00) 98.00(96.00–99.00) 0.304 ECG QRS duration 92.00(82.00-106.00) 94.00(85.00-106.50) 0.398 QT interval 364.00(340.00-400.00) 382.00(326.00-401.00) 0.762 Corrected QT interval 423.00(400.00-455.00) 437.00(412.00-456.50) 0.091 T wave peak-end time 107.37±21.96 109.51±20.24 0.583 QRS dispersion 28.00(20.00–40.00) 28.00(24.00–40.00) 0.173 RR interval 793.95±216.98 745.44±203.71 0.210 Hemoglobin 15.10(13.60–15.50) 15.10(12.40–15.50) 0.571 WBC 13480(11220–20390) 12000(11000–20585) 0.367 Platelet 243036±83488 227522±83454 0.306 BUN 42.00(31.00-55.25) 31.00(27.00-55.25) Creatinine 1.10(0.79–1.22) 1.00(0.79–1.19) 0.532 Sodium 139.08±5.99 139.59±5.47 0.633 Potassium 4.56±1.08 4.50±0.89 0.618 Glucose 144.00(108.00-167.00) 145.00(100.00-21600) 0.641 CRP 5.48(3.32–19.86) 5.55(3.43–12.38) 0.944 Maximum troponin 3.05(1.19–15.41) 2.58(0.55–12.58) 0.201 ALT 25.00(16.00–55.00) 29.10(16.00–54.00) 0.679 AST 31.00(17.90–98.00) 30.00(17.90–85.00) 0.807 LDL 135.00(110.00-138.00) 135.00(104.00-138.00) 0.906 HDL 36.77±5.42 36.42±4.41 0.742 Triglyceride 159.00(100.00-232.00) 200.00(99.83–224.00) 0.670 EF 45.00(35.00–50.00) 37.50(25.00–45.00) 0.107 Culprit lesion 0.040 LAD 57(43.2%) 23(56.1%) CX 22(16.7%) 1(2.4%) RCA 50(37.9%) 16(39.0%) Diagonal 3(2.3%) 0 OM 0 1(2.4%) Number of critically affected arteries 0.220 1 68(51.5%) 24(58.5%) 2 44(33.3%) 9(22.0%) 3 17(12.9%) 7(17.1%) 4 3(2.3%) 1(2.4%) Thrombus after PCI 24(18.2%) 6(14.6%) 0.600 Flow pattern after PCI 0.485 TIMI 0–1 0 0 TIMI-2 6(4.5%) 3(7.3%) TIMI-3 126(95.5%) 38(92.7%) iCEB 4.56±0.79 4.60±0.90 0.749 Categorical variables are given as number (percentage). Continuous variables are given as mean ± standard deviation or median (25th -75th percentiles) Comparisons are made with chi-square and student t test sor Mann Whitney-U test for categorical and continuous variables respectively. P < 0.05 is considered statistically significant. Final step of the analysis comprised the comparison of ECG parameters and iCEB between groups. Mean iCEB values were 4.60±0.90 and 4.56±0.79 for VF + and stable groups respectively. It was not found statistically significant ( P = 0.749). No significant differences were found between groups in terms of ECG parameters that were taken into consideration. Discussion Our study has established a new base for iCEB values in STEMI patients. It is found that electrically stable STEMI patients has a mean iCEB value that is not quite different from general population. However, calculating mathematical significance needs complete data sets. Additionally, this index can not be used as a feasible estimator on ventricular fibrillation in the setting of STEMI generally. To our knowledge, this is the first study that investigate iCEB in STEMI setting. iCEB was originally studied in arrhythmic conditions such as Brugada syndrome, LQTS, antiarrhythmic drug use ( 1 , 2 ). Robyns et al. (2016) showed in their final results that mean iCEB was 5.22±0.93 in LQTS, 3.52±0.43 in Brugada Syndrome and 4.24±0.5 in normal patients. In addition, Aşkın et al. (2021) stated that the mean iCEB of their control group was 4.9±0.4 ( 6 ). Despite the relationship between iCEB and various clinical conditions were studied as mentioned before, these studies mostly incorporate rare pathologies or specific populations. Our study is the first in the field that evaluates these values in STEMI patients. We showed that iCEB in electrically stable STEMI patients was concordant with general population with a mean of 4.56±0.79. Few studies evaluate this parameter’s value in context of chronic or acute coronary conditions ( 6 , 7 ). QT interval had been widely studied previously before the discovery of integrated depolarization-repolarization parameters such as iCEB. Shawn et al. (1990) suggested that in the setting of unstable angina pectoris resulting from LAD lesion, QT prolongation was seen in 8% (16 cases) ( 9 ). On the other hand, ischemia was found associated with shortened action potential, as a result of increased sympathetic activity in previous studies. In a study conducted by Cinca et al. (1981), after acute ST elevation myocardial infarction, QT interval shortening occurred in the acute phase of MI, but in the later stages of MI, as an opposite phenomenon, QT prolongation took place ( 10 , 11 ). Other studies suggested that QT interval returned to its original state in 7 days post-MI ( 12 , 13 ). These changes that create large and unpredictable QT and QRS fluctuation per case or time dependent during the immediate and subacute phases of MI, were partly thought to be linked to a variability of sympathetic and parasympathetic tonus. Apart from the incidence of prolonged QT interval in the setting of acute MI, the relation of prolonged QT interval to the ventricular tachycardia and fibrillation in the setting of MI was studied ( 14 , 15 ). These studies showed that increased sympathetic activity in the presence of prolonged QT interval was associated with an increased chance of the development of these mentioned arrhythmias. In our study, VF + group had a higher frequency of having previous chronic renal insufficiency and also LAD being the culprit lesion more frequently than CX or RCA do. As a consisting literature, Sugizaki et al. (2019) and Gheeraert et al. (2000) while they were working with out of hospital VF in STEMI patients, found out VF was significantly related to lesion in left coronary artery ( 16 , 17 ). They also stated that multivessel disease was a risk factor for VF development but our study groups, even though we did not have a deliberate design in the current state, was not different in this context. This provided a better comparison in iCEB measurements while avoiding another confounding factor. In our study group. As a different finding, our VF + group showed a distinctly lower frequency of CX involvement, this may be associated with an increased chance of VF development when a greater portion of myocardium is under ischemia, or due to the relatively low number of study group. Chronic renal insufficiency is known to cause cardiac arrhythmias in acute coronary syndromes, and our results are also compatible with current literature ( 18 ). Causative relationship of the combined sympathetic activity and prolonged QT interval to the development of ventricular fibrillation brings the question of whether a single combined parameter of these two conditions can predict VF after STEMI better. Even though there are not any studies that evaluate iCEB on STEMI, Akçay et al. (2021) brought the matter closer to our field, suggesting that an anti-ischemic drug, ranolazine caused no difference on iCEB in stable coronary artery disease patients ( 7 ). Rationale dictates that high iCEB leads to TdP but low iCEB leads to non TdP VF, but the facts dictate that MI is heterogeneous in this context. Study limitations Our study had some limitations; these were the single-center and retrospective design, the relatively lower number of patients and the lack of an “in study” control group as general population are the most important limitations. Our study evaluated solely STEMI patients and was a first in the area but since it has a retrospective design and conducted in an emergency setting, despite establishing the diagnosis of ventricular fibrillation on the patient’s monitor was easy, it was not always possible to determine if it is a torsadogenic or non-torsadogenic VF. This barrier could be responsible for the similarity of iCEB values between stable and VF + groups. Another limitation of this study was the lack of consistent information about the ischaemia time of the patients. In emergency setting, even though the duration of the chest pain is almost always asked to the patients, this information is usually not included in digital patient files, resulting the lack of a very important determinant of VT/VF. However, even if it is most probable that longer ischaemia time leads to more frequent arrhythmias, since a different iCEB value was not observed in VF group, the authors concluded that the effect of this time on the overall result may not be remarkable. In the future prospective trials and meta-analyses, these problems can be addressed easier, taking ischaemia times into consideration, dividing groups according to their VT patterns before experiencing VF, thus give way to assess iCEB values under this further classification. Conclusions Our study is a looking glass to a previously unexplored field. The definition of a base iCEB level for patients with STEMI will definitely be helpful in looking for new beneficial comparisons among specific STEMI subgroups on a larger population scale or different clinical conditions to STEMI, thus, these efforts will be the first step on a ladder in the future. Development of arrhythmias were not linked to the index. Stable and acute coronary diseases differ by the level of sympathetic activation, furthermore the phases of acute coronary diseases may further increase this controversy, resulting in a complicated variability in expected QTc/QRS of these both conditions. Abbreviations CBC Complete blood count CX Circumflex artery ECG Electrocardiogram ESRD End stage renal disease iCEB Index of Cardio Electrophysiologic Balance LAD Left anterior descending artery LQTS Long QT syndrome MI Myocardial infarction RCA Right coronary artery PCI Percutaneous coronary intervention STEMI ST segment elevation myocardial infarction VF Ventricular fibrillation VT Ventricular tachycardia TdP Torsades de pointes Declarations Ethics Approval and Consent to Participate Authors acquired ethics committee approval from Umraniye Training and Research Hospital Ethics Committee (decision number: 314, date: 18.11.2021). Related approvals were obtained from the hospital’s statistics and archive departments. All participants gave their informed consent regarding participating in the study. All data were anonymized for confidentiality. All of this study’s creation processes were in compliance with Helsinki Declaration. Consent for Publication All the authors have given consent for this paper to be published in BMC Cardiovascular Disorders. Availability of Data and Materials Not applicable Declaration of Conflicting Interests The authors have no conflicts of interest to declare. Ethical Statement The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Authors’ Contributions OD: Concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review. EY: Concept, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, manuscript review. KOK: Concept, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, manuscript review. BÖ: Design, data acquisition, manuscript editing, manuscript review. BB: Design, data acquisition, manuscript editing, manuscript review. Acknowledgements Not applicable. References Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. Evaluation of Index of Cardio-Electrophysiological Balance (iCEB) as a New Biomarker for the Identification of Patients at Increased Arrhythmic Risk. 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J Am Coll Cardiol. 2000;35(1):144 – 50. 10.1016/s0735-1097(99)00490-8 . PMID: 10636272. Lisowska A, Tycińska A, Knapp M, Lisowski P, Musiał WJ. The incidence and prognostic significance of cardiac arrhythmias and conduction abnormalities in patients with acute coronary syndromes and renal dysfunction. Kardiol Pol. 2011;69(12):1242–7. PMID: 22219098. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6584125","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466927902,"identity":"c90abc0d-11a0-47ba-b4c1-a4e696360913","order_by":0,"name":"Önder Demiröz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYHACAwYGNiDFzHyAIYGBGcRqOECcFna2BKgWRmK18PMYgGwAa8Grnl+6eePjirJt+fLNPN8kHu6wljM4f7DxME8Fgzy/GHbLJOccKzY8c+62ZWMz7zaJxDPpxgY3EhsO85xhMJw5OwG7q27kmEk2tt02YGbm3XYjse1w4rYbjA0HZ7YxJBjcxqnF/CdICxszzzOIlvMHgVr+4dVixgjSwsPMwwbRciCx4cDHBtxaJGekFUs2nLttIMHMZv4jsS3d2B7olwMfjkng9Au/RPLGjw1ltw3k+w8/NvzZZi0n2X/48IeEGht5fmnsWnACCdKUj4JRMApGwShAAQDky2SeGn5dawAAAABJRU5ErkJggg==","orcid":"","institution":"Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Önder","middleName":"","lastName":"Demiröz","suffix":""},{"id":466927904,"identity":"f241da2e-ce5d-47a0-9a72-8d92bac1334d","order_by":1,"name":"Ersin Yıldırım","email":"","orcid":"","institution":"Ümraniye Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Ersin","middleName":"","lastName":"Yıldırım","suffix":""},{"id":466927906,"identity":"a1310fd3-9733-42c2-b9cb-30a51e29cffa","order_by":2,"name":"Behzat Özdemir","email":"","orcid":"","institution":"Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Behzat","middleName":"","lastName":"Özdemir","suffix":""},{"id":466927908,"identity":"c4ac71aa-11aa-4711-905d-7370fd6f7132","order_by":3,"name":"Bayram Bağırtan","email":"","orcid":"","institution":"Istanbul Şafak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bayram","middleName":"","lastName":"Bağırtan","suffix":""},{"id":466927911,"identity":"24518a32-4900-43a3-bfeb-2cc9cb317a26","order_by":4,"name":"Kanber Öcal Karabay","email":"","orcid":"","institution":"Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kanber","middleName":"Öcal","lastName":"Karabay","suffix":""}],"badges":[],"createdAt":"2025-05-03 12:38:14","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6584125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6584125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109252494,"identity":"1751e1c4-404f-4449-b3ab-0ddf0014469d","added_by":"auto","created_at":"2026-05-14 09:27:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":293639,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6584125/v1/452771ea-ba8f-4381-bdff-28664bd491c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Cardio Electrophysiologic Balance Index in Myocardial Infarction with ST Segment Elevation","fulltext":[{"header":"Background","content":"\u003cp\u003eRisk stratification in sudden cardiac death due to ventricular arrhythmias is a challenging task for clinicians who work in emergency wards, intensive care units or cardiology departments. Ventricular arrhythmias are one of the main causes of death in hereditary or acquired heart diseases and drug intoxications. Prolonged QT is long used as a classic biomarker for torsades de pointes (TdP) associated ventricular arrhythmias in the context of long QT, but it is not seen valuable in nontorsadogenic VT/VF (Ventricular tachycardia/ventricular fibrillation), and thus new parameters combining repolarization and conduction times are needed (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndex of cardio electrophysiological balance (iCEB) is first introduced in rabbit models for predicting drug caused ventricular arrhythmias by Lu et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is introduced as a derivative of cardiac wavelength λ and calculated as dividing QT duration by QRS duration in a dimensionless fashion. Increasing the cardiac wavelength results in TdP and the opposite action causes non TdP ventricular arrhythmias (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These parameters were studied in patients with a variety of disorders such as hypertrophic cardiomyopathy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), end stage renal disease (ESRD) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), coronary slow flow and chronic coronary syndrome (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). An ESC statement paper on novel electrocardiographic indices in 2017 stated that iCEB (as classified under combined depolarization-repolarization indices) has value in predicting arrythmic occurences under dofetilide, digoxin, isoprenaline and long QT syndromes (LQTS), Brugada syndrome. Other than iCEB, there are several parameters of conduction-repolarization. QRSDx(Tp-e)/QRSd and QRSDx(Tp-e)/QRSdxQT are studied (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relationship of this index with ST segment elevation myocardial infarction (STEMI) has not yet been studied. The primary aim of our study is to form a baseline of iCEB measurements of STEMI patients. The secondary purpose is to assess whether increased or decreased iCEB is associated with increased incidence of ventricular fibrillation in ST elevation MI patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Population\u003c/h2\u003e \u003cp\u003eOur study has a retrospective design. Following ethics committee approval, patient database from a training and research hospital in Turkey was scanned for STEMI patients who were followed between January 2021 and January 2023. All of this study\u0026rsquo;s creation processes were in compliance with Helsinki Declaration. After evaluation of 976 patient files, 132 STEMI patients who did not have VF were randomly selected from database as the electrically stable group. 41 cases were identified as having experienced ventricular fibrillation in emergency room or during transfer before coronary intervention. Patients who had been on medications that alter QT time, antiarrhythmic drugs, who had a history of hypertrophic cardiomyopathy, long or short QT syndrome diagnosis, symptomatic arrhythmias, syncope/sudden cardiac death survival and end stage renal disease were excluded from the study to isolate the sole effect of MI on iCEB values as much as possible. The clinical and demographic characteristics of the patients were collected from the hospital records. Complete blood count (CBC) and biochemical tests had been performed using a Beckman Coulter LH-750 and a Beckman Coulter L\u0026times;20 respectively, and the results of each patient were also retrieved. The files of the patients were gathered from hospital archives and the first ECGs from emergency room/ambulance records were evaluated with the same standardized ECG ruler for measuring heart rate, QT, QTc, QRS duration, QRS dispersion, determining MI localization and iCEB. Since the study was retrospective in nature, the time interval between the onset of chest pain to the emergency ECG could not be obtained due to the heterogeneity of digital hospital records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 22 for Windows Evaluation Version statistical package. Distributions of continuous variables were evaluated using the Kolmogorov-Smirnov test. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (with 25th and 75th percentiles) according to their distribution patterns. Categorical variables were summarized as frequencies and their corresponding percentages. Differences between the two groups were determined by independent samples t-test or Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e test for continuous variables. Categorical variables were compared by chi-square or Fisher\u0026rsquo;s exact test for two choice and Phi and Cramer\u0026rsquo;s V test for multichoice categorical variables. A p level of \u0026lt;\u0026thinsp;0.05 was accepted as statistically significant with 95% confidence interval and 5% margin of error, all of the results were given from two tailed tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eMedian age was 54.00 (49.00\u0026ndash;64.00) and 58.00 (48.00\u0026ndash;65.00) for VF\u0026thinsp;+\u0026thinsp;and stable groups, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.987). There were no differences between groups in terms of female sex (12.2% vs. 25.8%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.069) and previous medical history. Chronic renal disease was significantly more frequent in VF\u0026thinsp;+\u0026thinsp;group (9.8% vs. 2.3%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034). There were no other differences in terms of medication history. Demographic and baseline medical comparison between the groups are given in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Parameters and Medical Features of the Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVF (-) (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVF (+) (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.00(48.00\u0026ndash;65.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.00(49.00\u0026ndash;64.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSyncope\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCardiac arrest\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAtrial arrhythmia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEPS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCAD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDM\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHypertension\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHyperlipidemia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRenal disease\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCOPD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCancer\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSmoking\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAntiplatelet drug use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBeta blocker use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eACEinh/ARB use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAntiischaemic drug use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMRA use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOAD/insulin use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStatin use\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCategorical variables are given as number (percentage). Continuous variables are given as\u003c/em\u003e median (25th -75th percentiles)\u003c/p\u003e \u003cp\u003e\u003cem\u003eComparisons are made with chi-square and Mann Whitney-U tests for categorical and continuous variables respectively. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients among both groups came to the emergency room predominantly with the complaint of chest pain (93.2% vs. 80.5% for stable and VF\u0026thinsp;+\u0026thinsp;groups, respectively. Out of hospital cardiac arrest with documented VF was the presentation of 6 patients (14.6%) in VF\u0026thinsp;+\u0026thinsp;group. Vitals which include systolic and diastolic blood pressures, heart rate and peripheral oxygen saturation were similar across the groups. In terms of hemogram, renal and hepatic function tests, lipid profile and troponin levels, results were also similar. Ejection fraction (EF) of every patient was obtained by transthoracic echocardiography (TTE) right before or the day after coronary intervention. EF measurements showed no difference (median 37.5 for VF\u0026thinsp;+\u0026thinsp;vs. 45 for stable group; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.107). After coronary imaging, it was shown that left anterior descending artery (LAD) was the most frequently encountered culprit lesion in both groups. While VF\u0026thinsp;+\u0026thinsp;group was more prone to LAD thrombosis than stable group, less likely to have a CX culprit (LAD thrombosis in 43.2% of stable group vs. 56.1% VF\u0026thinsp;+\u0026thinsp;group and CX thrombosis in 16.7% of stable vs. 2.1% of VF\u0026thinsp;+\u0026thinsp;group; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040). Other than culprit lesions, there were not any significant differences between the groups in terms of number of affected vessels, blood flow quality or thrombus burden after PCI. The laboratory, echocardiographic parameters and angiographic information is given in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVital, Clinical and Laboratory Parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVF (-) (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVF (+) (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresenting symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest pain: 123(93.2%)\u003c/p\u003e \u003cp\u003eSyncope: 6(4.5%)\u003c/p\u003e \u003cp\u003eDisturbed general condition: 3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChest pain: 33(80.5%)\u003c/p\u003e \u003cp\u003eCardiac arrest: 6(14.6%)\u003c/p\u003e \u003cp\u003eSyncope:2(4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical subtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior MI: 57(43.2%)\u003c/p\u003e \u003cp\u003eInferior/posterior/right MI: 72(54.5%)\u003c/p\u003e \u003cp\u003eLateral MI: 3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnterior MI: 22(53.7%)\u003c/p\u003e \u003cp\u003eInferior/posterior/right MI: 19(46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.80\u0026plusmn;25.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130.39\u0026plusmn;26.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.00(62.00-102.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.00(68.50\u0026ndash;95.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.32\u0026plusmn;24.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.83\u0026plusmn;20.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen saturation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.00(95.50\u0026ndash;98.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.00(96.00\u0026ndash;99.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQRS duration\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.00(82.00-106.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.00(85.00-106.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQT interval\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e364.00(340.00-400.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e382.00(326.00-401.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCorrected QT interval\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e423.00(400.00-455.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e437.00(412.00-456.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eT wave peak-end time\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107.37\u0026plusmn;21.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109.51\u0026plusmn;20.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eQRS dispersion\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.00(20.00\u0026ndash;40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.00(24.00\u0026ndash;40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRR interval\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e793.95\u0026plusmn;216.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e745.44\u0026plusmn;203.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.10(13.60\u0026ndash;15.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.10(12.40\u0026ndash;15.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13480(11220\u0026ndash;20390)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12000(11000\u0026ndash;20585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e243036\u0026plusmn;83488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e227522\u0026plusmn;83454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.00(31.00-55.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.00(27.00-55.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10(0.79\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00(0.79\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139.08\u0026plusmn;5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.59\u0026plusmn;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.56\u0026plusmn;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.50\u0026plusmn;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144.00(108.00-167.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145.00(100.00-21600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.48(3.32\u0026ndash;19.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.55(3.43\u0026ndash;12.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum troponin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.05(1.19\u0026ndash;15.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.58(0.55\u0026ndash;12.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.00(16.00\u0026ndash;55.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.10(16.00\u0026ndash;54.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.00(17.90\u0026ndash;98.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.00(17.90\u0026ndash;85.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135.00(110.00-138.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135.00(104.00-138.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.77\u0026plusmn;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.42\u0026plusmn;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglyceride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159.00(100.00-232.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200.00(99.83\u0026ndash;224.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.00(35.00\u0026ndash;50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.50(25.00\u0026ndash;45.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCulprit lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLAD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCX\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eRCA\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(39.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDiagonal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOM\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of critically affected arteries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68(51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(58.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombus after PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlow pattern after PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTIMI 0\u0026ndash;1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTIMI-2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTIMI-3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126(95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(92.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eiCEB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.56\u0026plusmn;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.60\u0026plusmn;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCategorical variables are given as number (percentage). Continuous variables are given as mean\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (25th -75th percentiles)\u003c/p\u003e \u003cp\u003e\u003cem\u003eComparisons are made with chi-square and student t test sor Mann Whitney-U test for categorical and continuous variables respectively. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFinal step of the analysis comprised the comparison of ECG parameters and iCEB between groups. Mean iCEB values were 4.60\u0026plusmn;0.90 and 4.56\u0026plusmn;0.79 for VF\u0026thinsp;+\u0026thinsp;and stable groups respectively. It was not found statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.749). No significant differences were found between groups in terms of ECG parameters that were taken into consideration.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study has established a new base for iCEB values in STEMI patients. It is found that electrically stable STEMI patients has a mean iCEB value that is not quite different from general population. However, calculating mathematical significance needs complete data sets. Additionally, this index can not be used as a feasible estimator on ventricular fibrillation in the setting of STEMI generally. To our knowledge, this is the first study that investigate iCEB in STEMI setting.\u003c/p\u003e \u003cp\u003eiCEB was originally studied in arrhythmic conditions such as Brugada syndrome, LQTS, antiarrhythmic drug use (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Robyns et al. (2016) showed in their final results that mean iCEB was 5.22\u0026plusmn;0.93 in LQTS, 3.52\u0026plusmn;0.43 in Brugada Syndrome and 4.24\u0026plusmn;0.5 in normal patients. In addition, Aşkın et al. (2021) stated that the mean iCEB of their control group was 4.9\u0026plusmn;0.4 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite the relationship between iCEB and various clinical conditions were studied as mentioned before, these studies mostly incorporate rare pathologies or specific populations. Our study is the first in the field that evaluates these values in STEMI patients. We showed that iCEB in electrically stable STEMI patients was concordant with general population with a mean of 4.56\u0026plusmn;0.79.\u003c/p\u003e \u003cp\u003eFew studies evaluate this parameter\u0026rsquo;s value in context of chronic or acute coronary conditions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). QT interval had been widely studied previously before the discovery of integrated depolarization-repolarization parameters such as iCEB. Shawn et al. (1990) suggested that in the setting of unstable angina pectoris resulting from LAD lesion, QT prolongation was seen in 8% (16 cases) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). On the other hand, ischemia was found associated with shortened action potential, as a result of increased sympathetic activity in previous studies. In a study conducted by Cinca et al. (1981), after acute ST elevation myocardial infarction, QT interval shortening occurred in the acute phase of MI, but in the later stages of MI, as an opposite phenomenon, QT prolongation took place (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Other studies suggested that QT interval returned to its original state in 7 days post-MI (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These changes that create large and unpredictable QT and QRS fluctuation per case or time dependent during the immediate and subacute phases of MI, were partly thought to be linked to a variability of sympathetic and parasympathetic tonus. Apart from the incidence of prolonged QT interval in the setting of acute MI, the relation of prolonged QT interval to the ventricular tachycardia and fibrillation in the setting of MI was studied (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These studies showed that increased sympathetic activity in the presence of prolonged QT interval was associated with an increased chance of the development of these mentioned arrhythmias.\u003c/p\u003e \u003cp\u003eIn our study, VF\u0026thinsp;+\u0026thinsp;group had a higher frequency of having previous chronic renal insufficiency and also LAD being the culprit lesion more frequently than CX or RCA do. As a consisting literature, Sugizaki et al. (2019) and Gheeraert et al. (2000) while they were working with out of hospital VF in STEMI patients, found out VF was significantly related to lesion in left coronary artery (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). They also stated that multivessel disease was a risk factor for VF development but our study groups, even though we did not have a deliberate design in the current state, was not different in this context. This provided a better comparison in iCEB measurements while avoiding another confounding factor. In our study group. As a different finding, our VF\u0026thinsp;+\u0026thinsp;group showed a distinctly lower frequency of CX involvement, this may be associated with an increased chance of VF development when a greater portion of myocardium is under ischemia, or due to the relatively low number of study group. Chronic renal insufficiency is known to cause cardiac arrhythmias in acute coronary syndromes, and our results are also compatible with current literature (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCausative relationship of the combined sympathetic activity and prolonged QT interval to the development of ventricular fibrillation brings the question of whether a single combined parameter of these two conditions can predict VF after STEMI better. Even though there are not any studies that evaluate iCEB on STEMI, Ak\u0026ccedil;ay et al. (2021) brought the matter closer to our field, suggesting that an anti-ischemic drug, ranolazine caused no difference on iCEB in stable coronary artery disease patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Rationale dictates that high iCEB leads to TdP but low iCEB leads to non TdP VF, but the facts dictate that MI is heterogeneous in this context.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eOur study had some limitations; these were the single-center and retrospective design, the relatively lower number of patients and the lack of an \u0026ldquo;in study\u0026rdquo; control group as general population are the most important limitations. Our study evaluated solely STEMI patients and was a first in the area but since it has a retrospective design and conducted in an emergency setting, despite establishing the diagnosis of ventricular fibrillation on the patient\u0026rsquo;s monitor was easy, it was not always possible to determine if it is a torsadogenic or non-torsadogenic VF. This barrier could be responsible for the similarity of iCEB values between stable and VF\u0026thinsp;+\u0026thinsp;groups. Another limitation of this study was the lack of consistent information about the ischaemia time of the patients. In emergency setting, even though the duration of the chest pain is almost always asked to the patients, this information is usually not included in digital patient files, resulting the lack of a very important determinant of VT/VF. However, even if it is most probable that longer ischaemia time leads to more frequent arrhythmias, since a different iCEB value was not observed in VF group, the authors concluded that the effect of this time on the overall result may not be remarkable. In the future prospective trials and meta-analyses, these problems can be addressed easier, taking ischaemia times into consideration, dividing groups according to their VT patterns before experiencing VF, thus give way to assess iCEB values under this further classification.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study is a looking glass to a previously unexplored field. The definition of a base iCEB level for patients with STEMI will definitely be helpful in looking for new beneficial comparisons among specific STEMI subgroups on a larger population scale or different clinical conditions to STEMI, thus, these efforts will be the first step on a ladder in the future. Development of arrhythmias were not linked to the index. Stable and acute coronary diseases differ by the level of sympathetic activation, furthermore the phases of acute coronary diseases may further increase this controversy, resulting in a complicated variability in expected QTc/QRS of these both conditions.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplete blood count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCircumflex artery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectrocardiogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESRD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEnd stage renal disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eiCEB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndex of Cardio Electrophysiologic Balance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeft anterior descending artery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLQTS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLong QT syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRight coronary artery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous coronary intervention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTEMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eST segment elevation myocardial infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVentricular fibrillation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVentricular tachycardia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTdP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTorsades de pointes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors acquired ethics committee approval from Umraniye Training and Research Hospital Ethics Committee (decision number: 314, date: 18.11.2021). Related approvals were obtained from the hospital\u0026rsquo;s statistics and archive departments. All participants gave their informed consent regarding participating in the study. All data were anonymized for confidentiality. All of this study\u0026rsquo;s creation processes were in compliance with Helsinki Declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors have given consent for this paper to be published in BMC Cardiovascular Disorders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeclaration of Conflicting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOD:\u0026nbsp;Concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review.\u003c/p\u003e\n\u003cp\u003eEY:\u0026nbsp;Concept, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, manuscript review.\u003c/p\u003e\n\u003cp\u003eKOK:\u0026nbsp;Concept, design, definition of intellectual content, literature search, manuscript preparation, manuscript editing, manuscript review.\u003c/p\u003e\n\u003cp\u003eB\u0026Ouml;: Design, data acquisition, manuscript editing, manuscript review.\u003c/p\u003e\n\u003cp\u003eBB: Design, data acquisition, manuscript editing, manuscript review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRobyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. 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PMID: 22219098.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ST elevation myocardial infarction, index of cardio electrophysiological balance, QT interval, QRS duration, Ventricular fibrillation","lastPublishedDoi":"10.21203/rs.3.rs-6584125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6584125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIndex of cardio electrophysiologic balance (iCEB) obtained from ECG (electrocardiogram) is used as a potential estimator of ventricular fibrillation (VF) in various clinical conditions. However, this index has not been evaluated in ST segment elevation myocardial infarction (STEMI). This paper evaluates basal iCEB values in STEMI patients and its potential for estimating VF development.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e173 patients with STEMI, including 132, who were stable and 41 patients with VF in acute setting were scanned retrospectively. After assessment of demographic variables and medical history, acute presentation ECGs were evaluated for iCEB. Values obtained from stable STEMI group were recorded and compared to the results of previous studies with known control group values. In addition, VF\u0026thinsp;+\u0026thinsp;and - groups were also compared by iCEB results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e39 out of 173 patients (22.5%) were female. Median age was 58 and 54 for VF (-) and (+) groups respectively. iCEB in electrically stable STEMI patients was similar or slightly increased than general population with a mean of 4.56\u0026plusmn;0.79. VF (+) group had more chronic renal disease (9.8% vs. 2.3%, p\u0026thinsp;=\u0026thinsp;0.034). Angiography results showed CX was less likely identified as the culprit lesion in VF (+) group (2.4% vs. 16.7%, p\u0026thinsp;=\u0026thinsp;0.040). iCEB measurements were found similar between groups (4.56\u0026plusmn;0.79 vs. 4.60\u0026plusmn;0.90, p\u0026thinsp;=\u0026thinsp;0.749).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study, we observed that iCEB values of stable STEMI patients were similar to previous studies, establishing an iCEB base for the STEMI population. Additionally, VF development is not linked to iCEB, therefore cannot be used as a predictor in emergency setting.\u003c/p\u003e","manuscriptTitle":"Evaluation of Cardio Electrophysiologic Balance Index in Myocardial Infarction with ST Segment Elevation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 15:45:26","doi":"10.21203/rs.3.rs-6584125/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7bd0d64a-dded-4abe-bb24-1355d0854f05","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-20T07:46:53+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T21:06:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-06 15:45:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6584125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6584125","identity":"rs-6584125","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}