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.
Journal of Electrocardiology
|July 30, 2022
Summary
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.
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