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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Variations of electrocardiographic parameters during hospitalization predict long-term outcomes in patients with
Guoyong Li1, Qiao Li1, Baotao Huang1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Electrocardiogram (ECG) changes from admission to discharge in non-ST-segment elevation myocardial infarction (NSTEMI) patients predict long-term outcomes. New-onset PtfV1 positive and prolonged QRS duration at discharge are key indicators of major adverse cardiac events (MACEs).
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Electrocardiogram (ECG) is vital for acute coronary syndrome (ACS) diagnosis and risk stratification.
- The long-term prognostic value of ECG variations in non-ST-segment elevation myocardial infarction (NSTEMI) requires further investigation.
Purpose of the Study:
- To investigate the long-term prognostic value of ECG parameter variations at admission and discharge in NSTEMI patients.
- To identify specific ECG changes that predict major adverse cardiac events (MACEs) during long-term follow-up.
Main Methods:
- A cohort of 170 NSTEMI patients was studied.
- ECGs were analyzed at admission and discharge.
- Long-term follow-up was conducted to assess survival differences and MACEs.
Main Results:
- Wider P wave, new-onset PtfV1 positive, and increased ST depression at discharge were associated with higher MACEs.
- New-onset PtfV1 positive during hospitalization (HR=4.705) and prolonged QRS duration at discharge (HR=2.536) were independent risk factors for MACEs.
- Diabetes mellitus, stage 3 hypertension, and multiple vessel lesions were also identified as risk factors.
Conclusions:
- Discharge ECG findings, specifically new-onset PtfV1 positivity and prolonged QRS duration, are independent predictors of recurrent MACEs in NSTEMI patients.
- Changes in ECG parameters between admission and discharge, including P-wave duration and ST-segment depression, provide significant long-term prognostic information for NSTEMI patients.
Background:
Electrocardiogram is an essential modality for diagnosis and early risk stratification for patients with acute coronary syndrome (ACS), but its long-term prognostic value has not been well studied. This study tried to investigate the long-term prognostic value of variations of ECG parameters at admission and discharge in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Methods:
A total of 170 NSTEMI patients were recruited consecutively from 2013 to 2014 in West China Hospital of Sichuan University. All subjects' ECGs at admission and discharge were reviewed. Follow-up was performed, and the survival difference between groups was analyzed.
Results:
Comparing with at admission, NSTEMI patients at discharge with a wider P wave (19.4% vs. 8.1%, p = 0.047), with new-onset PtfV1 positive (31.2% vs. 8.1%, 11.5%, 13.3%, p = 0.147) and with a greater number of leads showing ST depression (21.9% vs. 10.3%, p = 0.037) were prone to MACEs during long-term follow-up. The independent risk factors for the primary endpoints determined using a multivariate cox regression were new-onset PtfV1 positive during hospitalization (HR = 4.705, 95% CI = 1.457-15.197, p = 0.010) and prolonged QRS duration at discharge comparing to admission (HR = 2.536, 95% CI = 1.057-6.083, p = 0.030), besides diabetes mellitus, stage 3 hypertension, and multiple vessel lesions.
Conclusion:
Discharge ECG with new-onset PtfV1 positive and prolonged QRS duration were independent risk factors for recurrence of MACEs in NTEMI patients. The differences of ECG parameters between at admission and discharge, including P-wave duration, number of leads with ST-segment depression, carried long-term prognostic information for NSTEMI patients.
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