Key result
ST-segment depression and normal ECGs link to higher 30-day mortality versus T-wave inversion in NSTEMI.
Why the study?
This study aimed to assess the prognostic value of qualitative ECG findings at presentation in NSTEMI and clarify the influence of invasive treatment on their prognostic value.
Do admission ECG findings predict short-term mortality and major adverse events in patients with NSTEMI?
Cohort (n=7,684)
Yes
Do admission ECG findings predict short-term mortality and major adverse events in patients with NSTEMI?
p-value: p=<0.008
Admission ECG findings of ST-segment depression and no ischemic changes are associated with worse short-term outcomes compared to T-wave inversion in NSTEMI patients, but this prognostic value is lost in those receiving invasive management.
May refine short-term NSTEMI risk stratification by admission ECG; leaves open whether findings should guide management in prospective trials.
BACKGROUND: Admission 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). HYPOTHESIS: This 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. METHODS: We 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. RESULTS: STD 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. CONCLUSIONS: STD 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.
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Chen et al. (2020) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=7,684). Admission ECG findings (ST-segment depression or no ischemic changes) vs. T-wave inversion (TWI) was evaluated on In-hospital and 30-day mortality and major adverse events (MAE) (p=<0.008). Admission ECG findings of ST-segment depression and no ischemic changes were associated with significantly higher in-hospital and 30-day mortality and major adverse events compared to T-wave inversion in NSTEMI patients.
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