Predictive Value of Electrocardiogram for the Occurrence of Major Adverse Cardiac Events in Patients with Pulmonary Embolism

Abstract

Background Pulmonary embolism (PE) is one of the most prevalent cardiovascular diseases worldwide. A few studies have advocated the applicability of electrocardiogram (ECG) for the determination of prognosis of PE patients. Considering the low-cost and wide availability of ECG we aimed to investigate the association of selected ECG parameters with the occurrence of major adverse cardiac events (MACE) in PE patients. Methods In this study, 733 adult patients admitted with a definite diagnosis of acute PE were included from a registry of PE patients in a tertiary heart center. The patients’ clinical records were retrospectively reviewed, and demographic information, ECG abnormalities as well as the data on MACE (including hypotension, mechanical ventilation, Syncope, cardiogenic shock, or in-hospital mortality) were extracted. Results A total of 177 patients (24.1%) had MACE. Right bundle branch block (RBBB), incomplete RBBB, S1Q3T3, ST elevation in leads V1 or III, QR wave in lead V1, and inverted T wave in lead V1 to V4 were more frequently detected in the ECGs of patients who developed MACE (P values = 0.006, 0.030, 0.001, 0.001, 0.042, 0.001, and 0.001, respectively). The results of multivariate regression analysis demonstrated that ST-elevation in aVR (OR = 3.87, 95%CI = 2.32–6.44, P = 0.001) and S1Q3T3 (OR = 2.04, 95%CI = 1.22–3.43, P = 0.007) were independent predictors of MACE in PE patients. The sensitivities of ST elevation in the aVR lead and S1Q3T3 were 53.1% and 59.9%, and specificities were 79.7% and 68.1%, respectively. Conclusion Some ECG parameters including S1Q3T3 and ST elevation in aVR are independent predictors of MACE in patients with PE. Investigating these parameters in ECG can be helpful in the determination of the prognosis of PE patients.