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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,...

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Autores principales: 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
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
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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.
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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
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