AIM  To demonstrate the prognostic value of precordial total R wave amplitude/total (S wave+Q wave) amplitude ratio R/(S+Q) in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

  METHODS  In this retrospective study, we screened 273 patients with acute anterior STEMI who underwent PCI. Precordial R/(S+Q) was calculated at the time of hospital discharge. The primary endpoint was the major adverse cardiovascular event (MACE) and the secondary endpoint was any stent thrombosis at 2-year follow-up period.

  RESULTS  Compared with the R/(S+Q)≥0.51 group, the R/(S+Q)<0.51 group had significantly higher diabetes patients (P<0.05), higher CK-MB values (P<0.05), higher troponin I values (P<0.05), lower LVEF (P<0.05), longer QRS duration of precordial leads at discharge (P<0.01), more patients with pathological Q waves in precordial leads (P<0.01), and significantly lower total R-wave amplitude in precordial leads (P<0.01), The total amplitude of precordial leads (Q wave+S wave) increased significantly (P<0.01), and the R/(S+Q) of precordial leads decreased significantly (P<0.01). The area under the curve of R/(S+Q) ratio of ECG precordial lead to evaluate the risk of mace defined in this study is 0.711, with a sensitivity of 81.8%, a specificity of 55.7%, and an optimal cutoff value of 0.51. In Group R/(S+Q)<0.51, the involvement of criminal lesions in the proximal part of the left anterior descending branch was significantly higher than that in Group R/(S+Q)≥0.51, and the proximal part of the left anterior descending branch was the main one (P<0.01); The average diameter of each stent implanted in Group R/(S+Q)<0.51 was significantly higher than that in Group R/(S+Q)≥0.51 (P<0.01); During the 2-year clinical follow-up, the incidence of mace in the R/(S+Q)<0.51 group was significantly higher than that in the R/(S+Q)≥0.51 group (P<0.01); The incidence of heart failure was also significantly higher than that in the R/(S+Q)≥0.51 group (P<0.01). In the R/(S+Q)<0.51 group and the R/(S+Q)≥0.51 group, the 2-year cumulative survival rate without mace was 68.9% and 88.7% respectively (Log-rank P<0.01), and the cumulative survival rate without heart failure was 75.0% and 92.4% respectively (Log-rank, P<0.01). COX regression analysis showed that R/(S+Q) was an independent predictor of mace during the 2-year clinical follow-up (hazard ratio: 0.347, 95% CI: 0.143～0.844, P<0.05).

  CONCLUSION  During the 2-year clinical follow-up, the incidence of MACE in patients with R/(S+Q)<0.51 is significantly higher than that in patients with R/(S+Q)≥0.51 and R/(S+Q) is a risk factor in predicting poor outcomes in patients with acute anterior STEMI who underwent PCI.