Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

Yama Fakhri, Mads Ersbøll, Lars Køber, Christian Hassager, Rasmus Hesselfeldt, Jacob Steinmetz, Galen S Wagner, Maria Sejersten-Ripa, Jens Kastrup, Peter Clemmensen, Mikkel Malby Schoos

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).

METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.

RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).

CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.

Original languageEnglish
JournalJournal of Electrocardiology
Volume49
Issue number3
Pages (from-to)284-291
ISSN0022-0736
DOIs
Publication statusPublished - 1. May 2016

Fingerprint

Left Ventricular Function
Electrocardiography
ST Elevation Myocardial Infarction
Linear Models
Prospective Studies
Population

Keywords

  • Ischemia Acuteness STEMI
  • Ischemia Severity
  • Prehospital ECG

Cite this

Fakhri, Yama ; Ersbøll, Mads ; Køber, Lars ; Hassager, Christian ; Hesselfeldt, Rasmus ; Steinmetz, Jacob ; Wagner, Galen S ; Sejersten-Ripa, Maria ; Kastrup, Jens ; Clemmensen, Peter ; Schoos, Mikkel Malby. / Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction. In: Journal of Electrocardiology. 2016 ; Vol. 49, No. 3. pp. 284-291.
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title = "Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction",
abstract = "OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16{\%}) with (+SI, -AI), 110 (42{\%}) with (-SI, -AI), 90 (34{\%}) with (-SI, +AI), and 20 (8{\%}) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.",
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author = "Yama Fakhri and Mads Ersb{\o}ll and Lars K{\o}ber and Christian Hassager and Rasmus Hesselfeldt and Jacob Steinmetz and Wagner, {Galen S} and Maria Sejersten-Ripa and Jens Kastrup and Peter Clemmensen and Schoos, {Mikkel Malby}",
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Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction. / Fakhri, Yama; Ersbøll, Mads; Køber, Lars; Hassager, Christian ; Hesselfeldt, Rasmus; Steinmetz, Jacob; Wagner, Galen S; Sejersten-Ripa, Maria; Kastrup, Jens; Clemmensen, Peter; Schoos, Mikkel Malby.

In: Journal of Electrocardiology, Vol. 49, No. 3, 01.05.2016, p. 284-291.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

AU - Fakhri, Yama

AU - Ersbøll, Mads

AU - Køber, Lars

AU - Hassager, Christian

AU - Hesselfeldt, Rasmus

AU - Steinmetz, Jacob

AU - Wagner, Galen S

AU - Sejersten-Ripa, Maria

AU - Kastrup, Jens

AU - Clemmensen, Peter

AU - Schoos, Mikkel Malby

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.

AB - OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).METHODS: In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.RESULTS: In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).CONCLUSION: Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.

KW - Ischemia Acuteness STEMI

KW - Ischemia Severity

KW - Prehospital ECG

U2 - 10.1016/j.jelectrocard.2016.02.012

DO - 10.1016/j.jelectrocard.2016.02.012

M3 - Journal article

C2 - 26962019

VL - 49

SP - 284

EP - 291

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

IS - 3

ER -