Prognostic Significance of the Initial Electrocard

Authors: William R Hathaway Eric D Peterson Galen S Wagner Christopher B Granger K Michael Zabel Karen S Pieper Kathryn Andersen Clark Lynn H Woodlief Robert M Califf for the GUSTOI Investigators

Publish Date: 1998/02/04

Volume: 279, Issue: 5, Pages: 387-391

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Abstract

Patients— From the 41021 patients enrolled in the overall study we selected those who presented within 6 hours of chest pain onset with STsegment elevation and no confounding factors paced rhythms ventricular rhythms or left bundlebranch block on the ECG performed before thrombolysis was administered n=34166Results— Most ECG variables were associated with 30day mortality in a univariable analysis In a multivariable analysis combining the initial ECG variables and clinical predictors of mortality the sum of the absolute STsegment deviation both ST elevation and ST depression odds ratio OR 153 95 confidence interval CI 138169 ECG heart rate OR 149 95 CI 141159 QRS duration for anterior infarct OR 155 95 CI 143168 and ECG evidence of prior infarction for new inferior infarct OR 247 95 CI 202300 were the strongest ECG predictors of mortality A nomogram based on the multivariable model produced excellent discrimination of 30day mortality Cindex 0830Conclusions— In patients presenting with myocardial infarction accompanied by STsegment elevation components of the initial ECG help predict 30day mortality This information should be valuable in early risk stratification when the opportunity to reduce mortality is greatest and may help in assessing outcomes adjusted for patient risk

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