Abstract
Abstract: P5632
Global ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction
Authors:
C. Stengaard1, J.T. Sorensen2, M.P. Andersen3, K. Thygesen1, J.F. Lassen2, K. Nikus4, G. Wagner5, C.J. Terkelsen2, 1Aarhus University Hospital, Aarhus, Department of medicine and Cardiology A - Aarhus - Denmark, 2Aarhus University Hospital, Skejby, Department of Cardiology - Aarhus - Denmark, 3Aalborg University, Department of Health Science and Technology - Aalborg - Denmark, 4Tampere University Hospital, Department of Cardiology, Heart Center - Tampere - Finland, 5Duke University Medical Center, Department of Medicine, Division of Cardiology - Durham - United States of America,
Topic(s):
Infarction acute phase STEMI
Citation:
European Heart Journal ( 2011 ) 32 ( Abstract Supplement ), 1054
Purpose: A global ischemia ECG pattern (GIP) has been proposed for diagnosis of acute left main stem (LM) occlusion. The GIP is defined by ST-elevation of 1mm in lead aVR and ST-depression of 0.5mm in seven or more ECG leads. Previous studies focus on the sensitivity of GIP in patients with confirmed LM occlusion. We present data of prevalence and associated mortality of GIP in patients with suspected acute myocardial infarction (AMI).
Methods: The study population consists of 4905 patients suspected of AMI, transported by emergency medical service, in whom a prehospital ECG was acquired. GIP was identified by automated analysis using the Marquette 12SL algorithm. Data of mortality and angiography were obtained from the Danish cause of death registry and the Western Denmark Heart Registry. Prevalence and diagnostic performance of GIP was calculated. Kaplan Meier plots were constructed and mortality compared using log rank statistics.
Results: ECG's from 3402 patients qualified for analysis. 211 patients (6.2%) showed GIP pattern, 73 of these were diagnosed with myocardial infarction, of whom only 9 had an acute LM occlusion. This corresponds to a positive predictive value of GIP for identification of LM occlusion of 4.3%. Mortality in patients with GIP was significantly higher compared to patients without GIP (p<0.001) regardless of final diagnosis. Mortality in patients with AMI and GIP was significantly higher compared to patients with AMI and no GIP (p<0.001).
Conclusion: Despite previous reports of high sensitivity of GIP for identification of acute LM occlusions, the positive predictive value in an unselected population suspected of AMI is very low. However GIP is an independent predictor of poor outcome. Special attention should be given to these patients to provide optimal treatment.
Kaplan Meier plot.
Global ischemia ECG pattern for diagnosis of acute left main occlusion: prevalence and associated mortality in patients with suspected acute myocardial infarction
Authors:
C. Stengaard1, J.T. Sorensen2, M.P. Andersen3, K. Thygesen1, J.F. Lassen2, K. Nikus4, G. Wagner5, C.J. Terkelsen2, 1Aarhus University Hospital, Aarhus, Department of medicine and Cardiology A - Aarhus - Denmark, 2Aarhus University Hospital, Skejby, Department of Cardiology - Aarhus - Denmark, 3Aalborg University, Department of Health Science and Technology - Aalborg - Denmark, 4Tampere University Hospital, Department of Cardiology, Heart Center - Tampere - Finland, 5Duke University Medical Center, Department of Medicine, Division of Cardiology - Durham - United States of America,
Topic(s):
Infarction acute phase STEMI
Citation:
European Heart Journal ( 2011 ) 32 ( Abstract Supplement ), 1054
Purpose: A global ischemia ECG pattern (GIP) has been proposed for diagnosis of acute left main stem (LM) occlusion. The GIP is defined by ST-elevation of 1mm in lead aVR and ST-depression of 0.5mm in seven or more ECG leads. Previous studies focus on the sensitivity of GIP in patients with confirmed LM occlusion. We present data of prevalence and associated mortality of GIP in patients with suspected acute myocardial infarction (AMI).
Methods: The study population consists of 4905 patients suspected of AMI, transported by emergency medical service, in whom a prehospital ECG was acquired. GIP was identified by automated analysis using the Marquette 12SL algorithm. Data of mortality and angiography were obtained from the Danish cause of death registry and the Western Denmark Heart Registry. Prevalence and diagnostic performance of GIP was calculated. Kaplan Meier plots were constructed and mortality compared using log rank statistics.
Results: ECG's from 3402 patients qualified for analysis. 211 patients (6.2%) showed GIP pattern, 73 of these were diagnosed with myocardial infarction, of whom only 9 had an acute LM occlusion. This corresponds to a positive predictive value of GIP for identification of LM occlusion of 4.3%. Mortality in patients with GIP was significantly higher compared to patients without GIP (p<0.001) regardless of final diagnosis. Mortality in patients with AMI and GIP was significantly higher compared to patients with AMI and no GIP (p<0.001).
Conclusion: Despite previous reports of high sensitivity of GIP for identification of acute LM occlusions, the positive predictive value in an unselected population suspected of AMI is very low. However GIP is an independent predictor of poor outcome. Special attention should be given to these patients to provide optimal treatment.
Kaplan Meier plot.
| Original language | English |
|---|---|
| Journal | European Heart Journal |
| Volume | 32 |
| Issue | 417 |
| Pages (from-to) | 1054 |
| Number of pages | 1 |
| ISSN | 0195-668X |
| Publication status | Published - 2011 |