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Use of ischemic ECG patterns for risk stratification in intermediate-risk patients with acute PE.

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  • معلومة اضافية
    • المصدر:
      Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE
    • بيانات النشر:
      Publication: 1983- : Philadelphia, PA : W B Saunders
      Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
    • الموضوع:
      Risk Assessment*; Myocardial Ischemia/*diagnosis ; Pulmonary Embolism/*diagnosis ; Troponin T/*blood ; Ventricular Dysfunction, Right/*diagnosis; Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography ; Case-Control Studies ; Cohort Studies ; Echocardiography ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/etiology ; Pulmonary Embolism/complications ; Pulmonary Embolism/mortality ; Radionuclide Imaging ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/mortality ; Young Adult
    • نبذة مختصرة :
      Background: European recommendations on the management of acute pulmonary embolism (APE) divide patients into 3 risk categories: high, intermediate, and low. Mortality has previously been estimated at 3% to 15% in the intermediate group. The aim of this study was to use a new metric "ischemic electrocardiographic (ECG) patterns" to more precisely estimate the risk (complications or death) of APE patients identified as "intermediate risk" by current European Society of Cardiology (ESC) criteria.
      Methods: The study group consisted of 500 consecutive patients (290 females), with a mean age 66.3 ± 15.2 years, and 245 (72.8%) patients were initially classified as intermediate risk. Four ischemic ECG patterns were studied: (i) ST-segment ischemic pattern (STIP), (ii) global ischemic pattern (GIP), (iii) negative T wave pattern, and (iv) control group consisting of patients with no ischemic changes.
      Results: Predictors of death in univariate analysis included elevated troponin concentration (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.28-169; P = 0.02]) and ischemic ECG patterns: STIP (OR, 6.3; 95% CI, 1.6-46.0; P = 0.007). Patients with right ventricular dysfunction (RVD) who were STIP (+) experienced significantly higher mortality rate compared to RVD patients who were STIP(-) (11.4% vs 1.6%; OR, 7.26; 95% CI, 1.82-52.8; P = 0.004). In patients with STIP (+) as compared to STIP (-), rate of death (OR, 6.35; P = 0.007) and rate of complications (OR, 4.19; P = 0.002) were significantly higher. Neither presence of negative T-waves nor GIP pattern was associated with a worse prognosis.
      Conclusions: In patients with APE, an ischemic ECG pattern on hospital admission, when identified in addition to classic risk markers, is an independent risk factor for worse in-hospital outcomes.
      (Copyright © 2014 Elsevier Inc. All rights reserved.)
    • الرقم المعرف:
      0 (Troponin T)
    • الموضوع:
      Date Created: 20140830 Date Completed: 20141204 Latest Revision: 20241105
    • الموضوع:
      20250114
    • الرقم المعرف:
      10.1016/j.ajem.2014.07.029
    • الرقم المعرف:
      25167974