What question did this study set out to answer?

This research aims to evaluate the predictive significance of ST segment and QRS complex findings on admission ECG for outcomes in acute myocardial infarction patients.

August 11, 2026Journal of the American College of CardiologyOpen Access

Prognostic significance of the admission electrocardiogram in acute myocardial infarction

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=2603). Intervention: Distortion of the terminal portion of the QRS complex on admission ECG vs. Absence of QRS distortion. Primary outcome: Hospital mortality (OR 1.78, 95% CI 1.19 to 2.68, p=0.004).

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Key result

Terminal QRS distortion on admission ECG linked to ~78% higher hospital mortality.

OR 1.78
95% CI 1.19 to 2.68
P=0.004
n=2,603

Why the study?

Previous ECG risk stratification in acute myocardial infarction focused on ST segment elevation magnitude or lead count, prompting evaluation of a classification based on ST segment and terminal QRS distortion independent of absolute ST deviation.

Does distortion of the terminal portion of the QRS complex on admission ECG predict hospital mortality in patients with acute myocardial infarction receiving thrombolytic therapy?

Population

Patients with acute myocardial infarction receiving thrombolytic therapy with ST elevation and positive T waves

Comparison

Presence (1,371 patients) vs absence (1,232 patients) of terminal QRS distortion on admission ECG

Authors

YBYochai BirnbaumGeneral Cardiology IHIzhak HerzMaimonides Medical Center SSSamuel SclarovskyUniversidad de Los Andes

Discussion

Member takes

Implication

Distortion of the terminal portion of the QRS complex on admission ECG is an independent predictor of higher hospital mortality in patients with acute myocardial infarction treated with thrombolytics.

Key Points

This research aims to evaluate the predictive significance of ST segment and QRS complex findings on admission ECG for outcomes in acute myocardial infarction patients.
Patients with ST elevation and positive T waves receiving thrombolytic therapy were classified based on QRS complex distortion.
1,232 patients had no distortion while 1,371 had distortion of the QRS complex.
Statistical analysis included multivariable logistic regression to assess mortality outcomes.
Patients with QRS distortion had higher peak creatine kinase levels (1,617 vs. 1,080 IU, p = 0.00001).
Hospital mortality was significantly higher for those with QRS distortion (6.8% vs. 3.8%, p = 0.0008).
Distortion of the QRS complex was independently associated with hospital mortality (odds ratio 1.78, 95% CI 1.19 to 2.68, p = 0.004).

Study Design

Type

Cohort (n=2,603)

Structured PICO

Does distortion of the terminal portion of the QRS complex on admission ECG predict hospital mortality in patients with acute myocardial infarction receiving thrombolytic therapy?

Population

2,603 patients with acute myocardial infarction and ST elevation who received thrombolytic therapy, evaluated for QRS distortion on admission ECG.

Exposure

Presence of distortion of the terminal portion of the QRS complex on the admission ECG

Comparator

Absence of distortion of the terminal portion of the QRS complex on the admission ECG

Outcome

Hospital mortalityhard clinical

Main Result

Odds Ratio: 1.78 (95% CI 1.19–2.68)

Absolute Event Rate: 6.8% vs 3.8%

p-value: p=0.004

Cite This Study

Birnbaum et al. (1996) conducted a cohort in Acute myocardial infarction (n=2,603). Distortion of the terminal portion of the QRS complex on admission ECG vs. Absence of QRS distortion was evaluated on Hospital mortality (OR 1.78, 95% CI 1.19 to 2.68, p=0.004). Distortion of the terminal portion of the QRS complex on admission ECG was independently associated with higher hospital mortality (OR 1.78; 95% CI 1.19-2.68; P=0.004).

synapsesocial.com/papers/6a7ae906c671fb783371be63 https://doi.org/10.1016/0735-1097(96)00003-4

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Prognostic significance of the admission electrocardiogram in acute myocardial infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Prognostic significance of the admission electrocardiogram in acute myocardial infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider