Open AccessInitial electrocardiogram as determinant of hospital course in ST elevation myocardial infarction
Author(s) -
Millard Michael A.,
Nagarajan Vijaiganesh,
Kohan Luke C.,
Schutt Robert C.,
Keeley Ellen C.
Publication year - 2017
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12429
Subject(s) - medicine , cardiology , myocardial infarction , percutaneous coronary intervention , coronary artery disease , aspirin , diabetes mellitus , electrocardiography , heart failure , conventional pci , endocrinology
Background A proportion of patients with ST elevation myocardial infarction ( STEMI ) have an initial electrocardiogram ( ECG ) that is nondiagnostic and are definitively diagnosed on a subsequent ECG . Our aim was to assess whether patients with a nondiagnostic initial ECG are different than those with a diagnostic initial ECG . Methods We collected demographic, ECG , medication, angiographic, and in‐hospital clinical outcome data in consecutive patients undergoing primary percutaneous coronary intervention for STEMI at our institution from June 2009 to June 2013. Results A total of 334 patients were included, 285 (85%) diagnosed on the initial ECG and 49 (15%) on a subsequent ECG . Patients with a nondiagnostic initial ECG had more comorbidities including prior congestive heart failure (14% vs. 3%, p < .001), coronary artery disease (47% vs. 24%, p = .001), diabetes (37% vs. 16%, p = .001), and hyperlipidemia (55% vs. 40%, p = .048); higher rates of chronic medication use including aspirin (47% vs. 27%, p = .005), beta‐blocker (47% vs. 22%, p < .001), and statins (53% vs. 28%, p = .001); longer door‐to‐balloon times (106 min vs. 45 min, p < .001); lower peak troponin levels (25 ng/ml vs. 50 ng/ml, p = .004), longer diagnostic ECG to balloon times (84 min vs. 75 min, p = .006); and higher rates of a patent infarct‐related artery on baseline angiography (41% vs. 24%, p = .018) which remained significant in a multivariable logistic regression model. Conclusions Approximately one in seven STEMI patients had an initial ECG that was nondiagnostic for STEMI . These patients had more comorbidities, higher rates of medication use, and received delayed intervention (even after the diagnosis was definitive).