High-risk ECG patterns in ST elevation myocardial infarction for mortality prediction
Roope Lahti1, Jani Rankinen2, Leo-Pekka Lyytikäinen3
1Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center Tampere, Finland.
Insights
Elevated heart rate, atrial fibrillation, left bundle branch block (LBBB), and non-specific intraventricular conduction delay (NIVCD) on ECG predict worse survival in ST-elevation myocardial infarction (STEMI) patients. Ischemia severity did not impact prognosis.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) patterns are crucial for diagnosing and managing acute myocardial infarction (MI).
- Identifying prognostic markers in ST-elevation myocardial infarction (STEMI) is vital for patient outcomes.
Purpose of the Study:
- To investigate the prognostic significance of pre-intervention ECG patterns in STEMI patients undergoing emergent coronary angiography.
- To determine the association between various ECG findings and all-cause mortality.
Main Methods:
- Retrospective analysis of 1363 STEMI patients hospitalized between 2014-2018.
- Assessment of ECG variables including ST elevation, conduction disorders, arrhythmias, heart rate, and hypertrophy.
- Primary outcome: all-cause mortality assessed via Cox regression analysis.
Main Results:
- Higher heart rate (>100 bpm), atrial fibrillation/flutter, left bundle branch block (LBBB), and non-specific intraventricular conduction delay (NIVCD) were significantly associated with worse survival.
- Hazard ratios (HR) for these variables ranged from 1.85 to 2.62.
- Ischemia severity, based on ECG, was not linked to prognosis.
Conclusions:
- Specific ECG findings like elevated heart rate, atrial fibrillation, LBBB, and NIVCD are independent predictors of mortality in STEMI patients.
- These ECG markers can aid in risk stratification and management decisions for STEMI.
- Prognostic value of ischemia severity on initial ECG in STEMI requires further investigation.
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.
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