[The importance of a normal ECG in non-ST elevation acute coronary syndromes]
Rogério Teixeira1, Carolina Lourenço, Natália António
1Cardiology Department, University Hospitals and Medical School, Coimbra, Portugal. rogeriopteixeira@gmail.com
Insights
A normal electrocardiogram (ECG) in non-ST elevation acute coronary syndromes (ACS) indicates a better prognosis. Patients with normal ECGs had significantly higher survival rates at one year compared to those with abnormal ECGs.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Acute Coronary Syndromes
Context:
- Admission electrocardiograms (ECG) are crucial for diagnosing and managing non-ST elevation acute coronary syndromes (ACS).
- The prognostic value of a normal admission ECG in this patient population requires further elucidation.
Purpose:
- To evaluate the impact of admission ECG findings on the prognosis of patients with non-ST elevation ACS.
- To determine if a normal ECG is an early indicator of outcomes in non-ST elevation ACS.
Summary:
- A prospective observational study of 802 non-ST elevation ACS patients divided them into abnormal (n=538) and normal (n=264) ECG groups.
- Patients with normal ECGs exhibited better survival rates at one year (95.1% vs. 89.5%, p=0.012), with a hazard ratio of 0.45 (0.21-0.97) on Cox regression.
- No significant differences in Major Adverse Cardiovascular Events (MACE) rates were observed between groups.
Impact:
- A normal admission ECG serves as an early prognostic marker for favorable outcomes in non-ST elevation ACS.
- This finding can aid clinicians in risk stratification and treatment planning for ACS patients.
- Highlights the importance of ECG interpretation in acute cardiac care.
Background:
Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS).
Objective:
To assess the impact of the admission ECG on prognosis over non-ST ACS.
Population:
prospective, continuous, observational study of 802 non-ST ACS patients from a single center.
Methods:
Patients were divided in 2 groups: A (n=538) - Abnormal ECG and B (n=264) - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate.
Results:
Group A patients were older (68.7+/-11.7 vs. 63.4+/-12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01+/-10.55 vs. 55.34+/- 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97). There were no differences regarding the MACE rate.
Conclusion:
In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.
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