Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction
Key result
Persistent ischemic ECG signs linked to ~47% higher risk of major cardiovascular events in suspected AMI.
- HR 1.47
- 95% CI 1.02-2.13
- P=0.041
- n=1,675
Why the study?
Current guidelines recommend serial ECGs for persisting symptoms in suspected acute myocardial infarction, but the predictive value of ischemic ECG signs needed analysis.
Do persistent ischemic signs on short-term serial ECGs predict adverse cardiovascular events in patients with suspected AMI?
Population
1675 emergency department patients with suspected AMI, excluding ST-elevation AMI
Comparison
Persistent, new, or resolved ischemic signs vs no ischemic signs on serial ECGs
Design
Cohort study
Follow-up
2 years
Authors
Discussion
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Member takes
Implication
Persistent ischemic signs may flag higher long-term risk in suspected AMI; hypothesis-generating and should not yet change practice.
Study Design
Type
Cohort (n=1,675)
Multicenter
No
Structured PICO
Do persistent ischemic signs on short-term serial ECGs predict adverse cardiovascular events in patients with suspected AMI?
P
Population
1,675 adults (median age 65, 36% female) presenting to the emergency department with suspected acute myocardial infarction, excluding STEMI, followed for 2 years.
E
Exposure
Persistent ischemic ECG signs (ST-elevation, ST-deviation, T-wave inversion, ventricular arrhythmias, or bundle branch block) on both admission and 3-hour serial ECGs.
C
Comparator
No ischemic signs on either admission or 3-hour ECG.
O
Outcome
Composite of all-cause mortality, incident AMI, and coronary revascularization at 2 years (using a 30-day landmark analysis).composite
Main Result
Hazard Ratio: 1.47 (95% CI 1.02–2.13)
p-value: p=0.041
Short-term serial ECGs showing persistent ischemic signs can identify patients with suspected AMI who are at higher long-term risk for mortality and recurrent ischemic events.
Limitations
- Single-center study
- Enrollment not 24 hours a day leading to selection bias
- Small percentage of patients with ischemic ECG signs
- No access to ECGs obtained before initial presentation
- ECG results were not blinded to the treating physicians
- Enrollment not 24 h a day
- ECGs not blinded to physicians in the emergency department
Cite This Study
Lehmacher et al. (2020) conducted a cohort in Suspected acute myocardial infarction (n=1,675). Persistent ischemic ECG signs vs. No ischemic ECG signs was evaluated on Composite of all-cause mortality, incident AMI, and coronary revascularization (HR 1.47, 95% CI 1.02-2.13, p=0.041). In patients with suspected acute myocardial infarction, persistent ischemic ECG signs at admission and 3 hours predicted a significantly higher risk of all-cause mortality, incident AMI, and coronary revascularization compared to no ischemic signs (HR 1.47).