The Prognostic Significance of QTc Prolongation in Lead aVR in Patients with Acute Coronary Syndrome with ST
Abuzer Coskun1, Burak Demirci1, Mehmet Oktay Alkan1
1Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul 34200, Turkey.
Insights
Prolonged QTc interval is a significant predictor of mortality in acute coronary syndrome patients with aVR lead abnormalities. This finding offers valuable insights for risk stratification and patient management in emergency settings.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Electrocardiography
Background:
- Electrocardiographic parameters like aVR ST elevation/depression and QTc prolongation are vital in acute coronary syndrome (ACS).
- Predictive value of prolonged QTc in ACS patients with specific aVR lead changes requires further investigation.
Purpose of the Study:
- To evaluate the predictive value of prolonged QTc interval for mortality in emergency department patients diagnosed with ACS.
- To assess the association between QTc prolongation and electrocardiographic findings of ST elevation or depression in the aVR lead.
Main Methods:
- Retrospective analysis of 1273 emergency department patients with ACS (2020-2023).
- ECG parameters including aVR ST elevation/depression and QTc interval were documented.
- Demographics, complications, comorbidities, and 30/180-day mortality data were collected.
Main Results:
- Prolonged QTc was observed in patients with STEMI, NSTEMI, and mortality across both aVR-STE and aVR-STD groups (p < 0.001).
- Overall 30-day mortality was 10.1% and 180-day mortality was 14.2% (p < 0.001).
- Prolonged QTc demonstrated high sensitivity (99.7%) and specificity (99.2%) in predicting mortality (AUC: 0.983).
Conclusions:
- A prolonged QTc interval is an independent predictor of both short- and long-term mortality in ACS patients with aVR lead alterations.
- This finding can aid in identifying high-risk ACS patients in the emergency department.
- ECG-based risk stratification using QTc prolongation is crucial for ACS management.
Abstract:
Background and Objectives: In patients with acute coronary syndrome, electrocardiographic parameters, including ST elevation in lead aVR (aVR-STE), ST depression (aVR-STD), and QTc prolongation, are crucial. This study aims to show the predictive value of a longer QTc in emergency department patients with acute coronary syndrome and ≥1 mm ST elevation or depression in the aVR lead in electrocardiography. Materials and Methods: A retrospective analysis was conducted on 1273 patients admitted to the emergency department with a preliminary diagnosis of acute coronary syndrome between 2020 and 2023. ST depression, ST elevation, and QTc were documented in the electrocardiography of the patients. Furthermore, acute coronary syndrome subtypes were identified. Basic demographic characteristics, complications, concomitant diseases, and 30-day and 180-day mortality data were collected. Results: The mean age of 1273 patients included in the study was 63.23 (10.06) years and 548 (43%) were female (p = 0.030). In the aVR-STE group, the QTc was 483.31 (33.96) ms in STEMI, 474.98 (26.21) ms in NSTEMI, and 505.60 (9.76) ms in those with mortality (p < 0.001). In the aVR-STD group, the QTc was 465.10 (42.63) ms in STEMI, 457.52 (39.52) ms in NSTEMI, and 508.73 (4.71) ms in those with mortality (p < 0.001). The total 30-day mortality was 129 (10.1%) and 180-day mortality was 181 (14.2%) (p < 0.001). In the uni-multivariable regression analysis performed for both change in aVR derivation and mortality, it was determined that prolonging QTc could be a predictive value for acute coronary syndrome (p < 0.001). We found sensitivity at 99.7% and specificity at 99.2% in predicting mortality in patients with prolonged QTc (AUC: 0.983, 95% CI: 0.974-0.993, p < 0.001). Conclusions: In patients with acute coronary syndrome, a prolonged QTc is an independent predictor of short- and long-term mortality in alterations in aVR derivation.
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