Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction

Abstract

Background: Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown. Methods: We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up. Results: Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69–0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49–0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin ( p<0.001) as well as clinical judgment at 90 min ( p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality. Conclusions: The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information.

Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan

“…Whole-blood DNC has many additional attributes such as free radical scavenging, better oxygen delivery, and reduction in the degree of hemodilution and myocardial edema [ 8 ]. Various studies showed that whole-blood cardioplegia has added advantages over traditional cardioplegia in terms of shorter ICU stay and in-hospital stay, infrequent incidences of postoperative low cardiac output syndrome, low postoperative renal injury, and better myocardial protection in CABG surgery [ 9 , 10 , 11 ]. On the other hand, some reports described higher rate of acute renal injury, in-hospital mortality, and blood transfusion in elderly patients that received whole-blood cardioplegia compared with diluted cardioplegia [ 12 ].…”

The year in review: electrocardiogram analysis and acute coronary syndromes

“…In this report by Grimm et al, digital ECG measurements in 1300 patients that presented with a suspected ACS were assessed and a previously reported conventional summed STDS was compared with an adapted score termed the BASEL-Score that included lead aVR. 9 The accuracy of both methods to diagnose NSTEMI was determined as well as the ability to estimate two-year prognosis. In this study, ST-segment depression was measured at the J point + 60 ms.…”