Key result
Baseline ECG findings and poor left ventricular ejection fraction (<30%) were associated with higher 6-month mortality in NSTEMI patients, whereas troponin levels lacked prognostic significance.
Why the study?
This study was conducted to determine the relationship between ECG, echocardiography, and troponin, and to evaluate their prognostic relevance and significance in patients with NSTEMI.
Observational (n=221)
No
ECG and echocardiography findings, particularly ST-depression, atrial fibrillation, and low LVEF, are better predictors of 6-month adverse outcomes in NSTEMI patients than troponin levels.
ECG and LVEF may aid NSTEMI risk stratification; hypothesis-generating and should not change practice without prospective validation.
Abstract Background: Non ST segment elevation myocardial infarction (NSTEMI) is a clinical condition characterized by typical symptoms of myocardial ischemia along with electrocardiographic changes and a positive value of troponin. After presentation in emergency department these patients have their troponin I value and electrocardiography done. The echocardiography should also be performed in these patients. This study was conducted to determine the relationship between ECG, Echo and troponin and how prognostically these are relevant to each other along with their prognostic significance.Results: This observational study was conducted at tertiary care cardiac hospital on 221 patients diagnosed with the NSTEMI. The most frequent finding on presenting ECG was ST depression in anterior leads (V1-V6) in 27.6%. Median troponin I at presentation was 3.2 ng/dl and median ejection fraction was 45%. Overall all-cause mortality rate at 6-months was observed to be 8.6%, re-infarction in 5%, re-hospitalization in 16.3%, and heart failure in 25.3% was observed. However, mortality was higher for patients with baseline ECG findings of A-fib, generalized ST-depression , poor R-wave progression, Wellens sign, and T-wave inversion in inferior also mortality rate was relatively higher among patients with poor (<30%) LVEF. Conclusion: ECG and Echocardiography were prognostically significant and correlated better at 6 months. However Troponin lacks the association and prognostic significance at 6 months.
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Kumar et al. (2021) conducted an observational in Non ST segment elevation myocardial infarction (NSTEMI) (n=221). Baseline ECG, echocardiography, and troponin levels was evaluated on 6-month all-cause mortality, re-infarction, re-hospitalization, and heart failure. Baseline ECG findings and poor left ventricular ejection fraction (<30%) were associated with higher 6-month mortality in NSTEMI patients, whereas troponin levels lacked prognostic significance.
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