Cargando…
Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction
Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda,...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703328/ https://www.ncbi.nlm.nih.gov/pubmed/34945229 http://dx.doi.org/10.3390/jcm10245933 |
_version_ | 1784621437276913664 |
---|---|
author | Cipriani, Alberto D’Amico, Gianpiero Brunetti, Giulia Vescovo, Giovanni Maria Donato, Filippo Gambato, Marco Dall’Aglio, Pietro Bernardo Cardaioli, Francesco Previato, Martina Martini, Nicolò Perazzolo Marra, Martina Iliceto, Sabino Cacciavillani, Luisa Corrado, Domenico Zorzi, Alessandro |
author_facet | Cipriani, Alberto D’Amico, Gianpiero Brunetti, Giulia Vescovo, Giovanni Maria Donato, Filippo Gambato, Marco Dall’Aglio, Pietro Bernardo Cardaioli, Francesco Previato, Martina Martini, Nicolò Perazzolo Marra, Martina Iliceto, Sabino Cacciavillani, Luisa Corrado, Domenico Zorzi, Alessandro |
author_sort | Cipriani, Alberto |
collection | PubMed |
description | Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI. |
format | Online Article Text |
id | pubmed-8703328 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87033282021-12-25 Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction Cipriani, Alberto D’Amico, Gianpiero Brunetti, Giulia Vescovo, Giovanni Maria Donato, Filippo Gambato, Marco Dall’Aglio, Pietro Bernardo Cardaioli, Francesco Previato, Martina Martini, Nicolò Perazzolo Marra, Martina Iliceto, Sabino Cacciavillani, Luisa Corrado, Domenico Zorzi, Alessandro J Clin Med Article Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI. MDPI 2021-12-17 /pmc/articles/PMC8703328/ /pubmed/34945229 http://dx.doi.org/10.3390/jcm10245933 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Cipriani, Alberto D’Amico, Gianpiero Brunetti, Giulia Vescovo, Giovanni Maria Donato, Filippo Gambato, Marco Dall’Aglio, Pietro Bernardo Cardaioli, Francesco Previato, Martina Martini, Nicolò Perazzolo Marra, Martina Iliceto, Sabino Cacciavillani, Luisa Corrado, Domenico Zorzi, Alessandro Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title | Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title_full | Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title_fullStr | Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title_full_unstemmed | Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title_short | Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction |
title_sort | electrocardiographic predictors of primary ventricular fibrillation and 30-day mortality in patients presenting with st-segment elevation myocardial infarction |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703328/ https://www.ncbi.nlm.nih.gov/pubmed/34945229 http://dx.doi.org/10.3390/jcm10245933 |
work_keys_str_mv | AT ciprianialberto electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT damicogianpiero electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT brunettigiulia electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT vescovogiovannimaria electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT donatofilippo electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT gambatomarco electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT dallagliopietrobernardo electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT cardaiolifrancesco electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT previatomartina electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT martininicolo electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT perazzolomarramartina electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT ilicetosabino electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT cacciavillaniluisa electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT corradodomenico electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction AT zorzialessandro electrocardiographicpredictorsofprimaryventricularfibrillationand30daymortalityinpatientspresentingwithstsegmentelevationmyocardialinfarction |