Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction
Standard
Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction. / Fakhri, Yama; Ersbøll, Mads; Køber, Lars; Hassager, Christian; Hesselfeldt, Rasmus; Steinmetz, Jacob; Wagner, Galen S; Sejersten, Maria; Kastrup, Jens; Clemmensen, Peter; Schoos, Mikkel Malby.
In: J ELECTROCARDIOL, Vol. 49, No. 3, 11.03.2016, p. 284-291.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction
AU - Fakhri, Yama
AU - Ersbøll, Mads
AU - Køber, Lars
AU - Hassager, Christian
AU - Hesselfeldt, Rasmus
AU - Steinmetz, Jacob
AU - Wagner, Galen S
AU - Sejersten, Maria
AU - Kastrup, Jens
AU - Clemmensen, Peter
AU - Schoos, Mikkel Malby
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/3/11
Y1 - 2016/3/11
N2 - OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.
AB - OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.
KW - Acute Disease
KW - Algorithms
KW - Causality
KW - Comorbidity
KW - Denmark/epidemiology
KW - Diagnosis, Computer-Assisted/methods
KW - Electrocardiography/methods
KW - Emergency Medical Services/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Reproducibility of Results
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Sensitivity and Specificity
KW - Severity of Illness Index
KW - Ventricular Dysfunction, Left/diagnosis
U2 - 10.1016/j.jelectrocard.2016.02.012
DO - 10.1016/j.jelectrocard.2016.02.012
M3 - SCORING: Journal article
C2 - 26962019
VL - 49
SP - 284
EP - 291
JO - J ELECTROCARDIOL
JF - J ELECTROCARDIOL
SN - 0022-0736
IS - 3
ER -
