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.
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.
Authors: Ian J Neeland; Melanie S Sulistio; Douglas A Stoller; James A de Lemos; James M Atkins; Darren K McGuire Journal: J Electrocardiol Date: 2012-01-14 Impact factor: 1.438
Authors: Yochai Birnbaum; James Michael Wilson; Miquel Fiol; Antonio Bayés de Luna; Markku Eskola; Kjell Nikus Journal: Ann Noninvasive Electrocardiol Date: 2013-12-30 Impact factor: 1.468
Authors: Salah S Al-Zaiti; Clifton W Callaway; Teri M Kozik; Mary G Carey; Michele M Pelter Journal: J Am Heart Assoc Date: 2015-07-24 Impact factor: 5.501