Electrocardiographic presentation of global ischemia in acute coronary syndrome predicts poor outcome

Abstract

Background. Global ischemia (GI) electrocardiogram (ECG), wide-spread ST depression with inverted T waves maximally in leads V_4–5, and lead aVR ST elevation (STE), is a marker of an adverse outcome in patients with non-ST elevation acute coronary syndromes (ACS), perhaps because this pattern is indicative of left main stenosis. The prognostic value of this ECG pattern has not been established.

Aims. The distribution of ECG changes and the prognostic value of the GI ECG were studied.

Methods. ECGs of consecutive patients admitted with suspected ACS (n = 1,188) were classified into seven ECG categories: STE, Q waves without STE, left bundle branch block, left ventricular hypertrophy, GI ECG, other ST depression and/or T wave inversion, and other findings.

Results. The GI ECG pattern predicted a high rate (48%) of composite end-points (mortality, re-infarction, unstable angina, resuscitation, or stroke) at 10-month follow-up compared to the other ECG categories (36%) (HR 1.78; CI 95% 1.31–2.41; P < 0.001). In multivariate analysis, the GI ECG pattern was associated with a higher rate of composite end-points (HR 1.40; CI 95% 1.02–1.91; P = 0.035). The multivariate analysis furthermore identified age, creatinine level, and diabetes as independent predictors of prognosis.

Conclusions. The GI ECG pattern predicted an unfavorable outcome, when compared to other ECG patterns in patients with ACS.

Key words::

• Acute coronary syndrome
• electrocardiogram
• left main disease

Acknowledgements

This study was supported financially by The Pirkanmaa Regional Fund of the Finnish Cultural Foundation, Tampere, Finland.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.