Long-term outcomes in patients with acute myocardial infarction and no ischemic changes on electrocardiogram
Karolina Piątek1, ŁukaszPiątek1, Łukasz Zandecki1
1Collegium Medicum, Jan Kochanowski University, Żeromskiego 5, Kielce 25-369, Poland.
Insights
Patients with myocardial infarction (MI) and no ischemic changes (NIC) on ECG have a worse prognosis than previously believed. Their long-term outcomes are similar to those with ST-segment elevation (STE) MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Diagnostics
Background:
- Acute myocardial infarction (MI) diagnosis often relies on electrocardiography (ECG) ischemic changes.
- A notable patient subset presents with no ischemic changes (NIC) on ECG, exhibiting distinct characteristics and management.
- The prognostic implications of normal ECGs in MI patients require further clarification, especially with advanced troponin assays.
Purpose of the Study:
- To compare the clinical outcomes of myocardial infarction (MI) patients presenting with no ischemic changes (NIC) versus those with other ECG patterns.
- To evaluate the prognostic significance of various ECG findings in acute MI.
- To clarify the long-term prognosis for MI patients with non-ischemic ECG presentations.
Main Methods:
- Analysis of 155,073 patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS) between 2012-2018.
- Classification of MI patients into groups: no ischemic changes (NIC), ST-segment elevation (STE), ST-segment depression (STD), T-wave inversion (TWI), and other ST-T abnormalities (STT).
- Comparison of in-hospital and 12-month mortality rates across different ECG groups.
Main Results:
- The no ischemic changes (NIC) group comprised 9.56% of all MI patients.
- Patients with T-wave inversion (TWI) had a lower in-hospital mortality risk compared to the NIC group.
- ST-segment elevation (STE), ST-segment depression (STD), and other ST-T abnormalities (STT) groups showed worse short-term outcomes.
- At 12 months, TWI demonstrated the best prognosis, while STT and STD had the worst.
- The 12-month mortality rates for STE and NIC groups were similar (9.0% vs. 8.7%, P=0.534), despite STE being an independent predictor.
Conclusions:
- The long-term prognosis for myocardial infarction (MI) patients with no ischemic changes (NIC) on ECG is less favorable than previously assumed.
- The outcomes for NIC patients are comparable to those with T-wave inversion (TWI) and ST-segment elevation (STE) MI.
- These findings highlight the importance of considering non-ischemic ECG findings in MI prognostication.
Background:
Acute myocardial infarction (MI) is commonly associated with ischemic abnormalities on electrocardiography (ECG). However, a significant proportion of patients present with no ischemic changes (NIC), and their baseline characteristics and management differ considerably from those with other ECG patterns. In the era of rapid troponin assays, the exact prognostic effects of normal ECGs remain unclear.
Objectives:
This study aimed to compare the outcomes of patients with MI without ischemic changes and those with other ECG patterns.
Methods:
Between 2012 and 2018, 155,073 patients with MI were enrolled in the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS). The patients were assigned to one of the following groups: NIC, ST-segment elevation (STE), ST-segment depression (STD), T-wave inversion (TWI), and other ST-T abnormalities (STT).
Results:
The NIC group accounted for 9.56% of all patients. The in-hospital risk of death was lower in the TWI group than in the NIC group. In the STE, STD, and STT groups, the short-term results were substantially worse. During the 12-month observation period, TWI had the best prognosis. The worst long-term prognoses were associated with STT and STD. The outcomes of the STE and NIC groups were similar (12-month death rate 9.0% vs. 8.7%, respectively; P=0.534), despite the fact STE was an independent predictor of 12-month prognosis.
Conclusions:
The prognosis of patients with MI and NIC is not as favorable as previously thought. Their long-term outcomes were equal to those of the TWI and STE MI groups.
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