Prognostic value of admission electrocardiographic findings in non‐ST‐segment elevation myocardial infarction

Abstract

BackgroundAdmission electrocardiographic (ECG) findings of non‐ST‐segment elevation myocardial infarction (NSTEMI) include transient ST‐segment elevation (TSTE), ST‐segment depression (STD), T‐wave inversion (TWI), and no ischemic changes (NIC).HypothesisThis study aimed to assess the prognostic value of qualitative ECG findings at presentation and to clarify the influence of invasive treatment on the prognostic value of admission ECG findings.MethodsWe analyzed the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) study post hoc. NSTEMI patients were included and classified into four groups per ECG findings. Study endpoints were in‐hospital and 30‐day mortality rates and major adverse events (MAE). We performed multivariate logistic regression, adjusting for covariates in the Global Registry of Acute Coronary Events risk model, with subset analyses of patients treated with or without invasive management.ResultsSTD patients had significantly higher in‐hospital and 30‐day mortality rates/MAE than TWI patients, which had lower in‐hospital mortality rate/MAE than the NIC group. TSTE patients had intermediate outcomes. In multivariate logistic regression using the TWI group as the reference, STD and NIC remained independently associated with worse outcomes. Subset analysis showed prognostic value of admission ECG in non‐invasively managed but not in invasively managed patients.ConclusionsSTD was associated with adverse outcomes, TWI with benign prognoses. NIC should not be taken to indicate low risk. Qualitative analysis of admission ECG is suitable for rapid risk stratification of NSTMI patients at presentation. However, it may not be predictive of short‐term outcomes of NSTEMI patients after invasive management.

Metabolomics Study Revealing the Potential Risk and Predictive Value of Fragmented QRS for Acute Myocardial Infarction

“…The clinical features of AMI include persistent sternal pain, shock, arrhythmia, and heart failure, along with increased serum myocardial enzymes and electrocardiogram (ECG) changes. It has been proved that ECG plays an important role in the early diagnosis and prognostic information of AMI. − The main manifestation of ECG in AMI is ST-segment depression and elevation, T-wave flattening or inversion, and the formation of pathological Q wave. Fragmented QRS (fQRS) on 12-lead ECG is defined by the various RSR′ patterns (≥1 R′ or notching of S wave or R wave) with or without Q wave, in two or more contiguous leads corresponding to major coronary artery territories.…”

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

“…QRST angle) characteristics on the ECG prognostic of death and re-infarction with improved sensitivity [12,13,16]. Some characteristics of the ECG have a low sensitivity for a true infarction because the standard 10-second ECG is simply a snapshot of a very dynamic process [12,13,16]. Furthermore, the standard 12-lead ECG does not have posterior leads and can be easily misinterpreted [14,15].…”

“…We specify ECG in the emergency department to focus on initial emergency contact. Our expertise in this area have led us to hypothesize the following common and novel characteristics will likely be included: ST-segment depression, T-wave inversion, and QRS-T angle [12,13,16]. However, we will not limit our search to just these characteristics.…”

“…The ECG is crucial for informing initial treatments in UA/NSTEMI and has prognostic value for death and re-infarction, but has limitations and can be misinterpreted leading to an underestimation of ischemic injury [12]. The ECG is completed within the rst 10 minutes of patient presentation per current American Heart Association/ American College of Cardiology (AHA/ACC) guidelines which enable providers to rapidly stratify patients based on greatest risk for death and re-infarction [2].…”

“…Lastly, the ECG is often misinterpreted by providers further leading to treatment delays [14,15]. Newer research has identi ed novel characteristics on the ECG related to UA/NSTEMI which have higher sensitivity and the potential to overcome these identi ed limitations [12,16]. Collectively, the rapidness of the ECG to assess ischemic in UA/NSTEMI is a signi cant advantage but a number of limitations contribute to an underestimation of ischemic injury.…”