1
|
Lahti R, Rankinen J, Lyytikäinen LP, Eskola M, Nikus K, Hernesniemi J. High-risk ECG patterns in ST elevation myocardial infarction for mortality prediction. J Electrocardiol 2022; 74:13-19. [PMID: 35907279 DOI: 10.1016/j.jelectrocard.2022.07.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 12/13/2022]
Abstract
AIM We explored the pre-intervention (first medical contact) electrocardiographic (ECG) patterns and their relation to survival among patients with acute myocardial infarction, who presented either with ST elevation (ST elevation myocardial infarction, STEMI) or LBBB, and who underwent emergent coronary angiography in a region with a 24/7/365 STEMI network. METHODS This is a retrospective analysis of 1363 consecutive patients hospitalized for first STEMI between the years 2014 and 2018. We assessed the prognostic significance of a variety of ECG categories, including location of ST elevation, severity of ischemia, intraventricular and atrioventricular conduction disorders, atrial fibrillation or flutter, junctional rhythms, heart rate, left ventricular hypertrophy and Q waves. The primary outcome was all-cause mortality between January 2014 and the end of 2020. RESULTS The mean age of the patients was 67.9 (SD 12.8) years. The majority were treated by percutaneous coronary intervention (93.8%, n = 1278). Median follow-up time was 3.7 years (IQR 2.5-5.1 years) during which 22.5% (n = 307) of the patients died. According to Cox regression analysis, adjusted for pre-existing conditions and age, the ECG variables with statistically significant association with survival were elevated heart rate (>100 bpm) (HR 2.34, 95% CI 1.75-3.12), atrial fibrillation or flutter (HR 1.94, 95% CI 1.41-2.67), left bundle branch block (LBBB) (HR 2.62, 95% CI 1.49-4.63) and non-specific intraventricular conduction delay (NIVCD) (HR 1.85, 95% CI 1.22-2.89). CONCLUSION Higher heart rate, atrial fibrillation or flutter, LBBB and NIVCD are associated with worse outcome in all-comers with STEMI. Ischemia severity was not associated with impaired prognosis.
Collapse
Affiliation(s)
- Roope Lahti
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland.
| | - Jani Rankinen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland; Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
3
|
Han X, Chen Z, Wang Y, Zhang J, Zhang Y, Su Q, Pan Z, Sun J, Wang Y. Prognostic significance of QRS distortion and frontal QRS-T angle in patients with ST-elevation myocardial infarction. Int J Cardiol 2021; 345:1-6. [PMID: 34715207 DOI: 10.1016/j.ijcard.2021.10.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 10/22/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND QRS distortion (G3I) and frontal QRS-T angle (fQRS-T angle) are both electrocardiographic (ECG) signs of ongoing ischemia and depolarization-repolarization heterogeneity, which always occur in patients with ST-segment elevation acute myocardial infarction (STEMI). METHODS We retrospectively collected 592 STEMI patients who underwent coronary angiography and follow-up for 42 months. 1. We divided the patients into two groups according to whether they had G3I on admission, compared the differences in examination data and endpoint events between these two groups. 2. Group patients according to whether the endpoint events happened in hospital, at 12 and 42 months, compare whether there is a difference in fQRS-T angle at the same time point, and find out the predictive cutoff value of all-cause death. 3. Combined G3I and fQRS-T angle together to enhance the predictive value. RESULTS G3I and fQRS-T angle are both independent risk factors for all-cause death in STEMI patients within 12 months (G3I P = 0.014, fQRS-T angle P < 0.001) and within 42 months (P < 0.001). The cutoff values of fQRS-T angle for predicting all-cause death are 66.5° at 12 months and 90.5° at 42 months. When G3I and fQRS-T angle are combined used to predict the mortality, the specificity is significantly improved, but the sensitivity decreased. CONCLUSIONS G3I and fQRS-T angles are valuable in the prognostic assessment of STEMI patients, especially when combined. These findings help clinicians to identify high-risk patients early for more aggressive treatment.
Collapse
Affiliation(s)
- Xiaorong Han
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Zhongbo Chen
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Yinghui Wang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jin Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Ying Zhang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Qiang Su
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Zhenghu Pan
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Jian Sun
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| | - Yonggang Wang
- Department of Cardiovascular Center, Jilin University First Hospital, China.
| |
Collapse
|
4
|
Leivo J, Anttonen E, Jolly SS, Dzavik V, Koivumäki J, Tahvanainen M, Koivula K, Nikus K, Wang J, Cairns JA, Niemelä K, Eskola M. The prognostic significance of grade of ischemia in the ECG in patients with ST-elevation myocardial infarction: A substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial). J Electrocardiol 2021; 68:65-71. [PMID: 34365136 DOI: 10.1016/j.jelectrocard.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of the grade of ischemia (GI) ECG classification in the risk assessment of patients with STEMI has been shown previously. Grade 3 ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is defined as ST-elevation without QRS distortion. Our aim was to evaluate the prognostic impact of the GI classification on the outcome in patients with STEMI. METHODS 7,211 patients from the TOTAL trial were included in our study. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year. RESULTS The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; p=0.013) was also higher in patients with G3I. CONCLUSIONS G3I in the presenting ECG was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I. Patients with G3I also had a higher cardiovascular death compared to patients with G2I.
Collapse
Affiliation(s)
- Joonas Leivo
- Internal medicine, Kanta-Häme Central Hospital, Hämeenlinna, Ahvenistontie 20, 13530 Hämeenlinna, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Eero Anttonen
- Päijät-sote, Primary health care, Lahti, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; Hamilton Health Sciences, Hamilton, P.O. Box 2000, Hamilton, ON L8N 3Z5, Canada
| | - Vladimir Dzavik
- Peter Munk Cardiac Centre, University Health Network, Toronto, R. Fraser Elliott Building, 1st Floor 190 Elizabeth St., Toronto, ON M5G 2C4, Canada
| | - Jyri Koivumäki
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Minna Tahvanainen
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Kimmo Koivula
- Internal medicine, South Karelia Central Hospital, Valto Käkelän katu 1, Lappeenranta 53130, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Jia Wang
- Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada; David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Faculty of Health Sciences, 1280 Main St. W., Hamilton, Ontario L8S4K1, Canada
| | - John A Cairns
- The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T1Z4, Canada
| | - Kari Niemelä
- Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tays Sydänkeskus Oy, PL 2000, 33521 Tampere, Finland
| |
Collapse
|