Nigel S Tan1, Shaun G Goodman2, Raymond T Yan3, Mary K Tan4, Keith A A Fox5, Joel M Gore6, David Brieger7, Ph Gabriel Steg8, Anatoly Langer9, Andrew T Yan10. 1. Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. 2. Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada. 3. University of Toronto, Toronto, ON, Canada. 4. Canadian Heart Research Centre, Toronto, ON, Canada. 5. Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK. 6. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States. 7. Coronary Care Unit, Concord Hospital, Sydney, Australia. 8. DHU FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, INSERM, U1148 Paris, France. 9. University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada. 10. Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: yana@smh.ca.
Abstract
PURPOSE: To examine the prognostic significance of low QRS voltage in a large contemporary cohort of patients with a broad spectrum of acute coronary syndromes (ACS). METHODS: 12409 patients with STEMI or NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and Canadian ACS I registries were stratified based on the presence of low QRS voltage (<0.5 mV in all limb leads and <1.0 mV in all precordial leads) on the admission ECG. We performed multivariable logistic regression to assess the independent association between low voltage and in-hospital and 6-month mortality, and tested for its interaction with ST-segment deviation for these outcomes. RESULTS: Patients with low voltage (3.2%) had higher GRACE risk scores, rates of prior myocardial infarction, and pathological Q waves, with less prevalent ST-segment deviation and ST-segment depression. They had worse left ventricular function and higher unadjusted rates of in-hospital and 6-month mortality. After adjustment for established prognosticators in the GRACE risk models in multivariable analysis, low voltage was independently associated with higher in-hospital mortality (adjusted OR 1.77, 95% CI 1.13-2.78, P=0.013) and mortality/re-infarction (adjusted OR 1.42, 95% CI 1.05-1.93, P=0.023), but not 6-month mortality (adjusted OR 1.25, 95% CI 0.85-1.84, P=0.27). There was no significant interaction between low voltage and ST-segment deviation for any endpoint (interaction P>0.10 for all endpoints). CONCLUSIONS: Low QRS voltage was associated with previous myocardial infarction and adverse hemodynamic variables at presentation. After adjusting for other prognosticators, low voltage independently predicted higher in-hospital mortality. This increased risk was not modulated by concomitant ST-segment deviation.
PURPOSE: To examine the prognostic significance of low QRS voltage in a large contemporary cohort of patients with a broad spectrum of acute coronary syndromes (ACS). METHODS: 12409 patients with STEMI or NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and Canadian ACS I registries were stratified based on the presence of low QRS voltage (<0.5 mV in all limb leads and <1.0 mV in all precordial leads) on the admission ECG. We performed multivariable logistic regression to assess the independent association between low voltage and in-hospital and 6-month mortality, and tested for its interaction with ST-segment deviation for these outcomes. RESULTS:Patients with low voltage (3.2%) had higher GRACE risk scores, rates of prior myocardial infarction, and pathological Q waves, with less prevalent ST-segment deviation and ST-segment depression. They had worse left ventricular function and higher unadjusted rates of in-hospital and 6-month mortality. After adjustment for established prognosticators in the GRACE risk models in multivariable analysis, low voltage was independently associated with higher in-hospital mortality (adjusted OR 1.77, 95% CI 1.13-2.78, P=0.013) and mortality/re-infarction (adjusted OR 1.42, 95% CI 1.05-1.93, P=0.023), but not 6-month mortality (adjusted OR 1.25, 95% CI 0.85-1.84, P=0.27). There was no significant interaction between low voltage and ST-segment deviation for any endpoint (interaction P>0.10 for all endpoints). CONCLUSIONS: Low QRS voltage was associated with previous myocardial infarction and adverse hemodynamic variables at presentation. After adjusting for other prognosticators, low voltage independently predicted higher in-hospital mortality. This increased risk was not modulated by concomitant ST-segment deviation.
Authors: Jan Szewieczek; Zbigniew Gąsior; Jan Duława; Tomasz Francuz; Katarzyna Legierska; Agnieszka Batko-Szwaczka; Beata Hornik; Magdalena Janusz-Jenczeń; Iwona Włodarczyk; Krzysztof Wilczyński Journal: Age (Dordr) Date: 2016-04-02
Authors: Marta López-Castillo; Álvaro Aceña; Ana M Pello-Lázaro; Vanessa Viegas; Beatriz Merchán Muñoz; Rocío Carda; Juan Franco-Peláez; Maria Luisa Martín-Mariscal; Sem Briongos-Figuero; Jose Tuñón Journal: Ann Noninvasive Electrocardiol Date: 2020-08-26 Impact factor: 1.468