ECG-based Characteristics of Death or Re-infarction on the 12-Lead or 15-Lead ECG among UA/NSTEMI Patients: A Protocol for a Systematic Review and Meta-Analysis

Abstract

BackgroundThe incidence of unstable angina/ non-ST elevation MI (UA/NSTEMI) continues to rise, and despite treatment advancements the risks of death and re-infarction persist. The electrocardiogram (ECG) remains the first assessment of myocardial ischemia caused by UA/NSTEMI, and is performed within the first 10-minutes of emergency presentation. Once ischemia is identified on the ECG, interventions are delivered timely to decrease the risk of death and re-infarction. Since the ECG informs intervention decisions, it is crucial providers understand the prognostic value of individual characteristics on the ECG. However, characteristics on ECG are limited due to low sensitivity though newer research has aimed to overcome these limitations. This is the protocol for a systematic review and meta-analysis that will assess the significance of individual characteristics on the ECG for predicting death and re-infarction among UA/NSTEMI patients, and identify remaining gaps in clinical understanding of ECG.MethodsThis is the protocol for a systematic review and meta-analysis that will be conducted to assess the prognostic value of specific characteristics on the ECG in the emergency department for predicting re-infarction and death. Electronic databases and specific journals will be searched using predefined search terms to identify relevant studies. Eligible studies will include peer-reviewed research articles with empirical findings on the risk of re-infarction and death based on individual characteristics on the ECG. To be inclusive, we will assess characteristics on both the 12-lead and 15-lead ECG. Methodological quality of will be assessed with the Newcastle-Ottawa Quality Assessment Scale and GRADE criteria. A random effects meta-analysis and exploratory meta-regression will be conducted. Citations will be managed using EndNote X9. Meta-Essentials package for Microsoft Excel and STATA will be used to compute statistics.Discussion This study will systematically evaluate and quantitatively assess the evidence available on the prognostic value of individual characteristics on the ECG for the risk of death and re-infarction among UA/NSTEMI patients. By conducting this study, we will inform clinicians about the significance of characteristics on the ECG to better inform treatment decisions for UA/NSTEMI patients. Registration This systematic review and meta-analysis is registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID CRD42020158491).