Key result
ST-elevation in lead aVR on admission electrocardiogram independently predicted the occurrence of in-hospital major adverse cardiac events in patients with acute pulmonary embolism (OR 3.87).
Why the study?
Given its low cost and wide availability, the study evaluated whether selected ECG parameters predict major adverse cardiac events in patients with pulmonary embolism.
Do specific ECG parameters (such as ST elevation in aVR and S1Q3T3) predict in-hospital major adverse cardiac events in patients with acute pulmonary embolism?
Cohort (n=733)
No
Do specific ECG parameters (such as ST elevation in aVR and S1Q3T3) predict in-hospital major adverse cardiac events in patients with acute pulmonary embolism?
Specific ECG parameters, notably ST elevation in aVR and S1Q3T3, are independent predictors of in-hospital major adverse cardiac events in patients with acute pulmonary embolism and can aid in risk stratification.
ST-elevation in aVR may aid PE risk stratification; leaves open whether ECG parameters should guide therapy pending prospective validation.
Abstract Background Pulmonary embolism (PE) is one of the most prevalent cardiovascular diseases worldwide. A few studies have advocated the applicability of electrocardiogram (ECG) for the determination of prognosis of PE patients. Considering the low-cost and wide availability of ECG we aimed to investigate the association of selected ECG parameters with the occurrence of major adverse cardiac events (MACE) in PE patients. Methods In this study, 733 adult patients admitted with a definite diagnosis of acute PE were included from a registry of PE patients in a tertiary heart center. The patients’ clinical records were retrospectively reviewed, and demographic information, ECG abnormalities as well as the data on MACE (including hypotension, mechanical ventilation, Syncope, cardiogenic shock, or in-hospital mortality) were extracted. Results A total of 177 patients (24.1%) had MACE. Right bundle branch block (RBBB), incomplete RBBB, S1Q3T3, ST elevation in leads V1 or III, QR wave in lead V1, and inverted T wave in lead V1 to V4 were more frequently detected in the ECGs of patients who developed MACE (P values = 0.006, 0.030, 0.001, 0.001, 0.042, 0.001, and 0.001, respectively). The results of multivariate regression analysis demonstrated that ST-elevation in aVR (OR = 3.87, 95%CI = 2.32–6.44, P = 0.001) and S1Q3T3 (OR = 2.04, 95%CI = 1.22–3.43, P = 0.007) were independent predictors of MACE in PE patients. The sensitivities of ST elevation in the aVR lead and S1Q3T3 were 53.1% and 59.9%, and specificities were 79.7% and 68.1%, respectively. Conclusion Some ECG parameters including S1Q3T3 and ST elevation in aVR are independent predictors of MACE in patients with PE. Investigating these parameters in ECG can be helpful in the determination of the prognosis of PE patients.
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Salimi et al. (2021) conducted a cohort in Acute pulmonary embolism (n=733). ST elevation in lead aVR on ECG vs. Absence of ST elevation in lead aVR was evaluated on Major adverse cardiac events (MACE) (OR 3.87, 95% CI 2.32-6.44, p=0.001). ST-elevation in lead aVR on admission electrocardiogram independently predicted the occurrence of in-hospital major adverse cardiac events in patients with acute pulmonary embolism (OR 3.87).
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