STEMI patients with a nondiagnostic initial ECG had longer door-to-balloon times (106 vs 45 min, p<0.001) and higher rates of a patent infarct-related artery (41% vs 24%, p=0.018).
Cohort (n=334)
No
Does a nondiagnostic initial ECG predict different clinical characteristics and hospital course in STEMI patients compared to a diagnostic initial ECG?
STEMI patients with an initially nondiagnostic ECG have more comorbidities and experience significant delays in intervention compared to those with an initially diagnostic ECG.
Absolute Event Rate: 41% vs 24%
p-value: p=0.018
BACKGROUND: A proportion of patients with ST elevation myocardial infarction (STEMI) have an initial electrocardiogram (ECG) that is nondiagnostic and are definitively diagnosed on a subsequent ECG. Our aim was to assess whether patients with a nondiagnostic initial ECG are different than those with a diagnostic initial ECG. METHODS: We collected demographic, ECG, medication, angiographic, and in-hospital clinical outcome data in consecutive patients undergoing primary percutaneous coronary intervention for STEMI at our institution from June 2009 to June 2013. RESULTS: A total of 334 patients were included, 285 (85%) diagnosed on the initial ECG and 49 (15%) on a subsequent ECG. Patients with a nondiagnostic initial ECG had more comorbidities including prior congestive heart failure (14% vs. 3%, p < .001), coronary artery disease (47% vs. 24%, p = .001), diabetes (37% vs. 16%, p = .001), and hyperlipidemia (55% vs. 40%, p = .048); higher rates of chronic medication use including aspirin (47% vs. 27%, p = .005), beta-blocker (47% vs. 22%, p < .001), and statins (53% vs. 28%, p = .001); longer door-to-balloon times (106 min vs. 45 min, p < .001); lower peak troponin levels (25 ng/ml vs. 50 ng/ml, p = .004), longer diagnostic ECG to balloon times (84 min vs. 75 min, p = .006); and higher rates of a patent infarct-related artery on baseline angiography (41% vs. 24%, p = .018) which remained significant in a multivariable logistic regression model. CONCLUSIONS: Approximately one in seven STEMI patients had an initial ECG that was nondiagnostic for STEMI. These patients had more comorbidities, higher rates of medication use, and received delayed intervention (even after the diagnosis was definitive).
Millard et al. (Tue,) conducted a cohort in ST elevation myocardial infarction (n=334). Nondiagnostic initial ECG vs. Diagnostic initial ECG was evaluated on Patent infarct-related artery on baseline angiography (p=0.018). STEMI patients with a nondiagnostic initial ECG had longer door-to-balloon times (106 vs 45 min, p<0.001) and higher rates of a patent infarct-related artery (41% vs 24%, p=0.018).