Diana Rivero1, Mohammad Alhamaydeh2, Ziad Faramand3, Mohammad Alrawashdeh4, Christian Martin-Gill3, Clifton Callaway3, Barbara Drew5, Salah Al-Zaiti6. 1. Thomas Jefferson University Hospital, Philadelphia PA, United States. 2. Conemaugh Memorial Medical Center, Johnstown, PA. 3. University of Pittsburgh Medical Center (UPMC), Pittsburgh PA, United States; University of Pittsburgh, 3500 Victoria Street, Pittsburgh PA 15261, United States. 4. University of Pittsburgh, 3500 Victoria Street, Pittsburgh PA 15261, United States; Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA. 5. University of California San Francisco (UCSF), San Francisco, CA, United States. 6. University of Pittsburgh, 3500 Victoria Street, Pittsburgh PA 15261, United States. Electronic address: ssa33@pitt.edu.
Abstract
BACKGROUND: Nonspecific ST-T repolarization (NST) abnormalities alter the ST-segment for reasons often unrelated to acute myocardial ischemia, which could contribute to misdiagnosis or inappropriate treatment. We sought to define the prevalence of NST patterns in patients with chest pain and evaluate how such patterns correlate with the eventual etiology of chest pain and course of hospitalization. METHODS: This was a prospective observational study that included consecutive prehospital chest pain patients from three tertiary care hospitals in the U.S. Two independent reviewers blinded from clinical data audited the prehospital 12-lead ECG for the presence or absence of NST patterns (i.e., right or left bundle branch block, left ventricular hypertrophy with strain pattern, ventricular pacing, ventricular rhythm, or coarse atrial fibrillation). The primary outcome was 30-day major adverse cardiac events (MACE) defined as cardiac arrest, acute heart failure, post-discharge infarction, or all-cause death. RESULTS: The final sample included 750 patients (age 59 ± 17, 58% males). A total of 40 patients (5.3%) experienced 30-MACE and 131 (17.5%) had NST patterns. The presence of NST patterns was an independent multivariate predictor of 30-day MACE (9.9% vs. 4.4%, OR = 2.2 [95% CI = 1.1-4.5]. Patients with NST patterns had increased median length of stay (1.0 [IQR 0.5-3] vs. 2.0 [IQR 1-4] days, p < 0.05) independent of the etiology of chest pain. CONCLUSIONS: One in six prehospital ECGs of patients with chest pain has NST patterns. This pattern is associated with increased length of stay and adverse cardiac outcomes, suggesting the need of preventive measures and close follow up in such patients.
BACKGROUND: Nonspecific ST-T repolarization (NST) abnormalities alter the ST-segment for reasons often unrelated to acute myocardial ischemia, which could contribute to misdiagnosis or inappropriate treatment. We sought to define the prevalence of NST patterns in patients with chest pain and evaluate how such patterns correlate with the eventual etiology of chest pain and course of hospitalization. METHODS: This was a prospective observational study that included consecutive prehospital chest painpatients from three tertiary care hospitals in the U.S. Two independent reviewers blinded from clinical data audited the prehospital 12-lead ECG for the presence or absence of NST patterns (i.e., right or left bundle branch block, left ventricular hypertrophy with strain pattern, ventricular pacing, ventricular rhythm, or coarse atrial fibrillation). The primary outcome was 30-day major adverse cardiac events (MACE) defined as cardiac arrest, acute heart failure, post-discharge infarction, or all-cause death. RESULTS: The final sample included 750 patients (age 59 ± 17, 58% males). A total of 40 patients (5.3%) experienced 30-MACE and 131 (17.5%) had NST patterns. The presence of NST patterns was an independent multivariate predictor of 30-day MACE (9.9% vs. 4.4%, OR = 2.2 [95% CI = 1.1-4.5]. Patients with NST patterns had increased median length of stay (1.0 [IQR 0.5-3] vs. 2.0 [IQR 1-4] days, p < 0.05) independent of the etiology of chest pain. CONCLUSIONS: One in six prehospital ECGs of patients with chest pain has NST patterns. This pattern is associated with increased length of stay and adverse cardiac outcomes, suggesting the need of preventive measures and close follow up in such patients.
Authors: Jessica K Zègre-Hemsey; Melanie Hogg; Jamie Crandell; Michele M Pelter; Len Gettes; Eugene H Chung; David Pearson; Pilar Tochiki; Jonathan R Studnek; Wayne Rosamond Journal: J Electrocardiol Date: 2021-08-13 Impact factor: 1.438