Highlights
- •Specific ECG changes in acute myocardial infarction (AMI) can predict long-term mortality.
- •NSTE-ACS are not per se less severe events than STEMI regarding long-term mortality.
- •The absence of AMI-typical ECG changes is associated with favorable long-term outcome.
- •ST-segment depression and bundle branch block go along with high long-term mortality.
- •Especially these patients should be offered intensive secondary prevention.
Abstract
Background
The aim of this study was to examine the predictive value of specific changes in admission
ECG on long-term outcome in acute myocardial infarction (AMI).
Methods
From 2000 until 2017 all AMI cases (n = 9,689) in the study area of Augsburg, Germany, were prospectively recorded. For
this study, all patients with a first-time AMI, who survived the first 28 days, were
considered. Median observational time was 6.7 years (IQR: 3.6–10.9). Each case was
assigned to one of the following groups according to the admission ECG: ‘ST-segment
elevation’, ‘ST-segment depression’, ‘T-wave inversion’, ‘unspecific changes’, ‘normal
ECG’ and ‘bundle branch block’ (BBB). Multivariable adjusted COX regression models
were calculated to compare long-term all-cause mortality.
Results
The final regression model revealed a significantly higher mortality among patients
with BBB (HR: 1.52 [1.34–1.73], p-value: < 0.001) and ‘ST-segment depression’ (HR:
1.16 [1.03–1.29], p-value: 0.01252) compared to the STEMI group (reference group).
The ‘normal ECG’ group (HR: 0.76 [0.66–0.87], p-value: < 0.001) on the other hand
was associated with significantly lower long-term mortality. The ‘T-wave inversion’
group (HR: 1.08 [0.96–1.21]) and the ‘unspecific changes’ group (HR: 1.05 [0.94–1.17])
did not differ significantly from the STEMI group.
Conclusion
ST-segment depressions and BBB admission ECGs go along with higher long-term mortality
in AMI patients compared to STEMI cases. This should be taken into account by physicians
when treating patients with NSTEMIs. Only the complete absence of AMI-related ECG
changes predicts a more favorable outcome.
Keywords
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Article info
Publication history
Published online: March 19, 2022
Accepted:
March 8,
2022
Received in revised form:
March 1,
2022
Received:
February 1,
2022
Identification
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© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
