Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Lehmacher, Jonas; Neumann, Johannes; Sörensen, Nils Arne; Goßling, Alina; Haller, P; Hartikainen, Tau S; Clemmensen, Peter; Zeller, Tanja; Blankenberg, Stefan; Westermann, Dirk

doi:10.3390/jcm9072303

Cited by 15 publications

(12 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before novel innovations are available, serial ECGs provide a potential insight into the dynamic nature of coronary artery occlusion and the need for emergency reperfusion therapy if showing indicative changes such as evolving ST elevation. 4 , 24 …”

Section: Discussionmentioning

confidence: 99%

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Knoery

McEwan

Manktelow

et al. 2022

Clinical Cardiology

View full text Add to dashboard Cite

Background: Treatment decisions in myocardial infarction (MI) are currently stratified by ST elevation (ST-elevation myocardial infarction [STEMI]) or lack of ST elevation (non-ST elevation myocardial infarction [NSTEMI]) on the electrocardiogram.This arose from the assumption that ST elevation indicated acute coronary artery occlusion (OMI). However, one-quarter of all NSTEMI cases are an OMI, and have a higher mortality. The purpose of this study was to identify features that could help identify OMI.Methods: Prospectively collected data from patients undergoing percutaneous coronary intervention (PCI) was analyzed. Data included presentation characteristics, comorbidities, treatments, and outcomes. Latent class analysis was undertaken, to determine patterns of presentation and history associated with OMI.Results: A total of 1412 patients underwent PCI for acute MI, and 263 were diagnosed as OMI. Compared to nonocclusive MI, OMI patients are more likely to have fewer comorbidities but no difference in cerebrovascular disease and increased acute mortality (4.2% vs. 1.1%; p < .001). Of OMI, 29.5% had delays to their treatment such as immediate reperfusion therapy. With latent class analysis, while clusters of similar patients are observed in the data set, the data available did not usefully identify patients with OMI compared to non-OMI. Conclusion:Features between OMI and STEMI are broadly very similar. However, there was no difference in age and risk of cerebrovascular disease in the OMI/non-OMI group. There are no reliable characteristics therefore for identifying OMI versus non-OMI. Delays to treatment also suggest that OMI patients are still missing out on

show abstract

Section: Discussionmentioning

confidence: 99%

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Knoery

McEwan

Manktelow

et al. 2022

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…As no standardized chief complaint data were available for patients in 2017, and given the high incidence of cardiovascular disease in the Pakistani population, the rate of electrocardiogram (ECG) and troponin ordering in all patients ≥40 years of age was used to evaluate the quality of care for patients at risk for cardiovascular disease/acute coronary syndrome (ACS) [ 19 20 21 22 23 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes Following the Implementation of a Novel One-Year Training Program in Emergency Medicine in Karachi, Pakistan

Saleem

Ali

Khatri

et al. 2023

Annals of Global Health

View full text Add to dashboard Cite

Background: Most Emergency Departments (EDs) in low- and middle-income countries (LMICs), particularly in Pakistan, are staffed by physicians not formally trained in Emergency Medicine (EM). As of January 2022, there were only 13 residency training programs in EM throughout all of Pakistan. Therefore, an intermediate solution—a one-year training program in EM—was developed to build capacity. Objective: To determine the impact of a novel training program in EM on clinical metrics and outcomes. Methods: The first cohort of a novel, one-year training program—the Certification Program in Emergency Medicine (CPEM)—completed the program in June 2019. The program consisted of two arms: CPEM-Clinical (CPEM-C), which included physicians from the Indus Hospital and Health Network (IHHN) ED; and CPEM-Didactic (CPEM-D), which included physicians from EDs across Karachi. Both groups participated in weekly conferences, such as didactics, small group discussions, workshops, and journal clubs. CPEM-C learners also received clinical mentorship from local and international faculty. Mortality, length of stay (LOS), and time-to-evaluation, as well as metrics in four key areas—patients at risk for cardiovascular disease/acute coronary syndrome, sepsis, respiratory illness, and intra-abdominal trauma—were assessed before and after the initial cohort at IHHN and compared with other groups in IHHN. Findings and Conclusions: More than 125,000 patients were seen from July to December 2017 (pre-CPEM) and July to December 2019 (post-CPEM). Overall, there were significant improvements in all clinical metrics and outcomes, with the exception of LOS and time-to-evaluation, and a trend toward improved mortality. In comparing CPEM graduates to other groups in IHHN ED, most metrics and outcomes significantly improved or trended toward improvement, including mortality. Implementation of a medium-duration, intensive EM training program can help improve patient care and the development of EM as a new specialty in lower-resource settings.

show abstract

“…We will only include papers which performed the ECG in the supine position to reduce the risk of misinterpretation related to positional effects which ultimately impact the sensitivity [26]. We will include studies that conducted serial ECG measurements which may improve the sensitivity of ECG characteristics due to a number of reasons described in the introduction [27]. Similarly, we will include papers that follow patients for more than the 28-day cutoff but focus on the rst 28-days for this review.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

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

Dzikowicz

Mulligan

Carey

2020

Preprint

View full text Add to dashboard Cite

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).

show abstract

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Cited by 15 publications

References 40 publications

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Clinical Outcomes Following the Implementation of a Novel One-Year Training Program in Emergency Medicine in Karachi, Pakistan

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

Contact Info

Product

Resources

About