Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI

Rikke Hansen, Martin Frydland, Ole Kristian Møller-Helgestad, Matias Greve Lindholm, Lisette Okkels Jensen, Lene Holmvang, Hanne Berg Ravn, Jesper Kjærgaard, Christian Hassager, Jacob Eifer Møller

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Abstract

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±13years, 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 (<89ms, 89-98ms, 99-111ms and >111ms). 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 98ms (IQR 88-112ms). 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>111ms (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.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume249
Pages (from-to)55-60
ISSN0167-5273
DOIs
Publication statusPublished - 15. Dec 2017

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Electrocardiography
Confidence Intervals

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@article{6185475232954ec49baf4d8b258fc43f,
title = "Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI",
abstract = "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±13years, 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 (<89ms, 89-98ms, 99-111ms and >111ms). 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 98ms (IQR 88-112ms). 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>111ms (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.",
author = "Rikke Hansen and Martin Frydland and M{\o}ller-Helgestad, {Ole Kristian} and Lindholm, {Matias Greve} and Jensen, {Lisette Okkels} and Lene Holmvang and Ravn, {Hanne Berg} and Jesper Kj{\ae}rgaard and Christian Hassager and M{\o}ller, {Jacob Eifer}",
note = "Copyright {\circledC} 2017 Elsevier B.V. All rights reserved.",
year = "2017",
month = "12",
day = "15",
doi = "10.1016/j.ijcard.2017.07.049",
language = "English",
volume = "249",
pages = "55--60",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier",

}

Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI. / Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian; Lindholm, Matias Greve; Jensen, Lisette Okkels; Holmvang, Lene; Ravn, Hanne Berg; Kjærgaard, Jesper; Hassager, Christian; Møller, Jacob Eifer.

In: International Journal of Cardiology, Vol. 249, 15.12.2017, p. 55-60.

Research output: Contribution to journalJournal articleResearchpeer-review

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±13years, 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 (<89ms, 89-98ms, 99-111ms and >111ms). 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 98ms (IQR 88-112ms). 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>111ms (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±13years, 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 (<89ms, 89-98ms, 99-111ms and >111ms). 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 98ms (IQR 88-112ms). 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>111ms (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

VL - 249

SP - 55

EP - 60

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -