TY - JOUR
T1 - Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI
AU - Hansen, Rikke
AU - Frydland, Martin
AU - Møller-Helgestad, Ole Kristian
AU - Lindholm, Matias Greve
AU - Jensen, Lisette Okkels
AU - Holmvang, Lene
AU - Ravn, Hanne Berg
AU - Kjærgaard, Jesper
AU - Hassager, Christian
AU - Møller, Jacob Eifer
N1 - Copyright © 2017 Elsevier B.V. All rights reserved.
PY - 2017/12/15
Y1 - 2017/12/15
N2 - Background QRS duration has previously shown association with mortality in patients with acute myocardial infarction treated with thrombolytics, less is known in patients with suspected ST segment elevation myocardial infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus, the objective was to investigate the prognostic effect of QRS duration on prehospital ECG and presence of classic left and right bundle branch block (LBBB/RBBB) for all-cause mortality in patients with suspected STEMI. Method In total 2105 consecutive patients (mean age 64 ± 13 years, 72% men) with suspected STEMI were prospectively included. QRS duration was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (< 89 ms, 89–98 ms, 99–111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality. Predictors of all-cause mortality were assessed using Cox proportional hazards analysis. Results Among all patients median QRS duration was 98 ms (IQR 88–112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB in 88 patients (4.2%), 80% were treated with percutaneous coronary intervention and the final diagnosis was STEMI in 1777 patients (84%). Thirty-day mortality was 7.6% in patients with suspected STEMI. In multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95% confidence interval (CI): 1.71–5.57, p = 0.0002), LBBB – morphology (HR 3.0; 95% CI: 1.38–6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95–6.95, p < 0.0001) were associated with 30 day all-cause mortality. Conclusion In patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on prehospital ECG are associated with increased risk of death.
AB - Background QRS duration has previously shown association with mortality in patients with acute myocardial infarction treated with thrombolytics, less is known in patients with suspected ST segment elevation myocardial infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus, the objective was to investigate the prognostic effect of QRS duration on prehospital ECG and presence of classic left and right bundle branch block (LBBB/RBBB) for all-cause mortality in patients with suspected STEMI. Method In total 2105 consecutive patients (mean age 64 ± 13 years, 72% men) with suspected STEMI were prospectively included. QRS duration was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (< 89 ms, 89–98 ms, 99–111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality. Predictors of all-cause mortality were assessed using Cox proportional hazards analysis. Results Among all patients median QRS duration was 98 ms (IQR 88–112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB in 88 patients (4.2%), 80% were treated with percutaneous coronary intervention and the final diagnosis was STEMI in 1777 patients (84%). Thirty-day mortality was 7.6% in patients with suspected STEMI. In multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95% confidence interval (CI): 1.71–5.57, p = 0.0002), LBBB – morphology (HR 3.0; 95% CI: 1.38–6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95–6.95, p < 0.0001) were associated with 30 day all-cause mortality. Conclusion In patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on prehospital ECG are associated with increased risk of death.
U2 - 10.1016/j.ijcard.2017.07.049
DO - 10.1016/j.ijcard.2017.07.049
M3 - Journal article
C2 - 29121757
SN - 0167-5273
VL - 249
SP - 55
EP - 60
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -