Key result
Grade 3 ischemia on presenting ECG links to ~27% higher 1-year major event risk versus Grade 2.
Why the study?
The prognostic impact of the grade of ischemia ECG classification in patients with STEMI required further evaluation.
Does Grade 3 ischemia on presenting ECG increase the risk of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure in patients with STEMI?
Cohort (n=7,211)
Does Grade 3 ischemia on presenting ECG increase the risk of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure in patients with STEMI?
Hazard Ratio: 1.27 (95% CI 1.04–1.55)
Absolute Event Rate: 9.8% vs 6.4%
p-value: p=0.022
Grade 3 ischemia on presenting ECG in STEMI patients is associated with a significantly higher risk of cardiovascular death, recurrent MI, cardiogenic shock, or severe heart failure at one year compared to Grade 2 ischemia.
Grade 3 ischemia may aid STEMI risk stratification; leaves open whether it should alter reperfusion or adjunctive therapy without prospective validation.
BACKGROUND: The importance of the grade of ischemia (GI) ECG classification in the risk assessment of patients with STEMI has been shown previously. Grade 3 ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is defined as ST-elevation without QRS distortion. Our aim was to evaluate the prognostic impact of the GI classification on the outcome in patients with STEMI. METHODS: 7,211 patients from the TOTAL trial were included in our study. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year. RESULTS: The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; p=0.013) was also higher in patients with G3I. CONCLUSIONS: G3I in the presenting ECG was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I. Patients with G3I also had a higher cardiovascular death compared to patients with G2I.
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Leivo et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=7,211). Grade 3 ischemia (G3I) on presenting ECG vs. Grade 2 ischemia (G2I) was evaluated on composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year (adjusted HR 1.27, 95% CI 1.04 - 1.55, p=0.022). Grade 3 ischemia on presenting ECG was associated with a higher 1-year risk of cardiovascular death, recurrent MI, shock, or heart failure compared to Grade 2 (9.8% vs 6.4%; HR 1.27; p=0.022).
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