Key result
Ischaemic J waves on admission are linked to ~9.7-fold higher odds of ventricular fibrillation.
Why the study?
This study was conducted to determine the ischaemic J wave pattern associated with ventricular fibrillation in STEMI patients.
Does the presence of an ischaemic J wave on admission ECG predict the occurrence of ventricular fibrillation in patients with STEMI?
Cohort (n=262)
Single-blind (Outcome assessors blinded)
No
Does the presence of an ischaemic J wave on admission ECG predict the occurrence of ventricular fibrillation in patients with STEMI?
Identifying ischaemic J waves on the initial ECG provides a critical early marker for a highly increased risk of ventricular fibrillation in patients presenting with STEMI.
Ischaemic J waves on admission ECG were associated with VF in STEMI; extends observational data but leaves clinical adoption open pending validation.
BACKGROUND: This study determined the ischaemic J wave pattern associated with ventricular fibrillation (VF). METHODS: A total of 262 patients diagnosed with ST-elevation myocardial infarction (STEMI) were recruited from October 2017 to September 2020. All data were collected and analysed, including baseline characteristics, electrocardiogram (ECG), coronary angiography (CAG), and examination outcomes. RESULTS: There were 193 STEMI patients with J wave elevation but without an ischaemic J wave (NJ group) and 69 patients with an ischaemic J wave; the latter were then subgrouped into early repolarization pattern (ERP; n=62) and Brugada pattern groups (BrP [anteroseptal ERP]; n=7). Univariate and multivariate logistic regression analyses were used to clarify high-risk factors and characteristics of ischaemic J waves. Multivariate logistic regression analysis revealed that an ischaemic J wave (odds ratio [OR], 9.708; 95% CI, 2.570-36.664; P=0.01) independently predicted VF. In the subgroup analysis, BrP (OR, 31.214; 95% CI, 3.949-246.742; P=0.001), slur morphology of the ERP (OR, 8.15; 95% CI, 1.563-42.558; P<0.05), and the number of leads with an ischaemic J wave > 3 (OR, 16.174; 95% CI, 3.064-85.375; P=0.001) were significantly associated with VF occurrence after adjusting for multiple variables. CONCLUSION: An ischaemic J wave is an independent risk factor for VF in STEMI patients. BrP, slur morphology, and > 3 leads with an ischaemic J wave could increase the incidence of VF.
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Zhang et al. (2021) conducted a cohort in ST-Elevation Myocardial Infarction (STEMI) (n=262). Ischaemic J wave pattern vs. Absence of ischaemic J wave (J wave elevation only) was evaluated on Occurrence of ventricular fibrillation (VF) recorded by ECG from the time of symptom onset (OR 9.708, 95% CI 2.570-36.664, p=0.01). The presence of an ischaemic J wave on admission independently predicted the occurrence of ventricular fibrillation (OR 9.708), with the Brugada pattern and slur morphology conferring particularly high risk.
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