Key result
Prolonged QTc was highly predictive of mortality in patients with acute coronary syndrome and ST alterations in lead aVR.
Why the study?
Electrocardiographic parameters including QTc prolongation in lead aVR have uncertain prognostic value in patients with acute coronary syndrome with ST elevation or depression.
Does QTc prolongation predict 30-day and 180-day mortality in patients with acute coronary syndrome and ST alterations in lead aVR?
Cohort (n=1,273)
Does QTc prolongation predict 30-day and 180-day mortality in patients with acute coronary syndrome and ST alterations in lead aVR?
Answers are grounded in this paper and cite their sources.
Prolonged QTc is a highly accurate independent predictor of short- and long-term mortality in patients presenting with acute coronary syndrome and ST segment alterations in lead aVR.
Background and Objectives: In patients with acute coronary syndrome, electrocardiographic parameters, including ST elevation in lead aVR (aVR-STE), ST depression (aVR-STD), and QTc prolongation, are crucial. This study aims to show the predictive value of a longer QTc in emergency department patients with acute coronary syndrome and ≥1 mm ST elevation or depression in the aVR lead in electrocardiography. Materials and Methods: A retrospective analysis was conducted on 1273 patients admitted to the emergency department with a preliminary diagnosis of acute coronary syndrome between 2020 and 2023. ST depression, ST elevation, and QTc were documented in the electrocardiography of the patients. Furthermore, acute coronary syndrome subtypes were identified. Basic demographic characteristics, complications, concomitant diseases, and 30-day and 180-day mortality data were collected. Results: The mean age of 1273 patients included in the study was 63.23 (10.06) years and 548 (43%) were female (p = 0.030). In the aVR-STE group, the QTc was 483.31 (33.96) ms in STEMI, 474.98 (26.21) ms in NSTEMI, and 505.60 (9.76) ms in those with mortality (p < 0.001). In the aVR-STD group, the QTc was 465.10 (42.63) ms in STEMI, 457.52 (39.52) ms in NSTEMI, and 508.73 (4.71) ms in those with mortality (p < 0.001). The total 30-day mortality was 129 (10.1%) and 180-day mortality was 181 (14.2%) (p < 0.001). In the uni-multivariable regression analysis performed for both change in aVR derivation and mortality, it was determined that prolonging QTc could be a predictive value for acute coronary syndrome (p < 0.001). We found sensitivity at 99.7% and specificity at 99.2% in predicting mortality in patients with prolonged QTc (AUC: 0.983, 95% CI: 0.974–0.993, p < 0.001). Conclusions: In patients with acute coronary syndrome, a prolonged QTc is an independent predictor of short- and long-term mortality in alterations in aVR derivation.
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Coşkun et al. (2024) conducted a cohort in Acute coronary syndrome (n=1,273). Prolonged QTc was evaluated on Mortality (AUC 0.983, 95% CI 0.974-0.993, p=<0.001). Prolonged QTc was highly predictive of mortality in patients with acute coronary syndrome and ST alterations in lead aVR.
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