QT Dispersion as A Predictor of In-Hospital Major Adverse Cardiovascular Events in Acute Myocardial Infarction

Victoria Handoyo*, I Kadek Susila Surya Darma, I Made Putra Swi Antara

Abstract

Background: Acute myocardial infarction (AMI) is known to be associated with a high incidence of major adverse cardiovascular events (MACE). Various scoring systems have been widely used to predict MACE in AMI patients; however, these scoring systems require laboratory tests that are relatively expensive and may not be available in all healthcare facilities, especially in rural areas. QT dispersion (QTd) has the potential to serve as a relatively quick, inexpensive, and widely accessible alternative. Objective: This study aims to analyze the relationship between QT dispersion and in-hospital MACE in patients with acute myocardial infarction (STEMI and NSTEMI). Methods: This was an analytical observational study with a prospective cohort design. The prospective cohort study involved acute myocardial infarction (AMI) patients who were hospitalized at Prof. Dr. I.G.N.G. Ngoerah General Hospital. QT dispersion was measured at admission as QT max – QT min. The QT interval was measured across all twelve leads using the tangent method. A follow-up was conducted during hospitalization to assess the occurrence of MACE. Interobserver reliability was assessed using the Cohen’s kappa test. The optimal QTd cutoff point for predicting MACE was determined using the Receiver Operating Characteristic (ROC) curve. A test of proportion comparison was used to assess the relationship between QTd and MACE. Multivariate Cox regression analysis was used to identify independent predictors, with results reported as adjusted hazard ratios (AHR). Results: A total of 122 patients were included in this study. The optimal QTd cutoff to predict MACE was found to be 51 ms (AUC 0.7; sensitivity 69.4%; specificity 61.7%). In the Chi-square test, high QTd (RR 2.1; 95% CI 1.3–3.0; p = 0.001) was associated with in-hospital MACE. A history of beta-blocker use was associated with lower QTd values (p = 0.02). In the multivariate analysis, QTd was an independent predictor of in-hospital MACE (AHR 1.8; 95% CI 1.02–3.3; p = 0.04). In addition, three other factors were identified as significant independent risk factors for MACE after adjustment: CKD (AHR 2.7; 95% CI 1.39–5.5; p = 0.004), history of diuretic use (AHR 4.2; 95% CI 2.2–7.9; p < 0.0001), and ACS type (STEMI had a 2.54-fold higher risk of in-hospital MACE compared with NSTEMI; 95% CI 1.1–5.9; p = 0.03). Conclusion: Increased QT dispersion (>51 ms) may serve as a predictor of in-hospital MACE among acute myocardial infarction patients at Prof. I.G.N.G. Ngoerah General Hospital.

Keywords

QT dispersion; acute myocardial infarction; major adverse cardiovascular events; STEMI; NSTEMI

Cite This Article

Handoyo, V., Darma, I. K. S. S., Antara, I. M. P. S. (2025). QT Dispersion as A Predictor of In-Hospital Major Adverse Cardiovascular Events in Acute Myocardial Infarction. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 6: Nov – Dec 2025, Pages 1068-1078 URL: https://www.ijscia.com/wp-content/uploads/2025/11/Volume6-Issue6-Nov-Dec-No.975-1068-1078.pdf

Volume 6 | Issue 6: Nov – Dec 2025