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Electrocardiographic predictors of mortality in patients after percutaneous coronary interventions - a nested
Jin Li1, Dominic Wyrsch2, Dik Heg3
1a Department of Physiology, University of Bern , Bern , Switzerland.
Insights
A longer QT interval predicts a higher risk of death within one year after percutaneous coronary intervention (PCI). This electrocardiogram (ECG) finding is crucial for identifying high-risk patients post-PCI.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Preventive Medicine
Background:
- Patient outcomes after percutaneous coronary interventions (PCI) show significant variability.
- Emerging electrocardiogram (ECG) parameters, alongside traditional markers, are being investigated for prognostic value in coronary artery disease.
- The prognostic significance of various ECG parameters in the context of PCI outcomes requires further elucidation.
Purpose of the Study:
- To comprehensively evaluate the predictive role of multiple ECG parameters in patients undergoing PCI.
- To determine the association between specific ECG intervals and mortality risk within one year post-PCI.
- To integrate novel and traditional ECG markers for improved risk stratification after PCI.
Main Methods:
- A nested case-control study design involving 3342 patients undergoing PCI between 2009 and 2013.
- Matching 644 non-surviving patients (cases) within one year post-PCI with 4 living patients (controls).
- Statistical analysis to assess the association between ECG parameters and mortality, adjusting for clinical and angiographic factors.
Main Results:
- A longer heart rate-corrected QT interval (using Bazett's formula) was significantly associated with an increased risk of death post-PCI (adjusted OR 1.07; 95% CI 1.01-1.12, p=0.022).
- Other investigated ECG parameters did not show a statistically significant association with mortality after adjustment for confounders.
- The QT interval emerged as a key independent predictor of short-term mortality in this PCI cohort.
Conclusions:
- The QT interval is a significant prognostic marker for identifying patients at elevated risk of death in the first year following PCI.
- Routine assessment of the QT interval may aid in optimizing post-PCI patient management and risk stratification.
- Further research could explore the mechanisms linking QT interval prolongation to adverse outcomes after revascularization.
Abstract:
Background: The outcome of patients undergoing percutaneous coronary interventions (PCIs) varies considerably. Several ECG parameters have recently emerged (PQ interval, P-wave, T-peak-to-T-end interval, T-wave, T/R ratio, J-wave) beyond traditional markers (rhythm, QRS, Q-wave, QT interval, ST segment) and were attributed important prognostic value in the setting of coronary artery disease. The present study integrated for the first time these ECG parameters altogether with the aim to determine their role in predicting patients' outcome after a PCI. Methods: A total of 3342 patients were enrolled in the present study between 2009 and 2013. In a nested case-control design, 644 patients who died within a year post-PCI (cases) were matched 1:4 with patients alive at that particular date (controls). Results: Our data showed that only the presence of a longer QT interval (heart rate-corrected using Bazett formula) was associated with increased risk of death after adjusting for multiple clinical and angiographic risk factors (adjusted OR 1.07; 95%CI 1.01-1.12, p = .022). Conclusion: Our study emphasises the prognostic importance of the QT interval in identifying patients at increased risk of death during the first year after PCI. Clinical Trial Registration - URL: https://www.clinicaltrials.gov . Unique identifier: NCT02241291.
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