Author + information
- Rikke Hansena,b,
- Martin Frydlanda,b,
- Matias G. Lindholma,b,
- Ole Moller-Helgestada,b,
- Jesper Kjaergaarda,b,
- Lisette Jensena,b,
- Lene Holmvanga,b,
- Hanne B. Ravna,b,
- Christian Hassagera,b and
- Jacob Møllera,b
Background: QRS duration has previously shown association with mortality in patients with acute myocardial infarction (MI) from the thrombolytic era. The prognostic value of QRS duration on prehospital electrocardiogram (ECG) in patients with ST segment elevation MI (STEMI) has not previously been assessed. 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.
Methods: 1044 consecutive patients (mean age 63.7±12.8 years, 70.9% men) with suspected STEMI were prospectively included. QRS was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (<89 ms, 89-99 ms, 99-110 ms and >110 ms). Primary endpoint was all-cause 90-day mortality. Predictors of all-cause mortality were assessed using Cox proportional Hazards analysis.
Results: In 907 patients (86.9%) diagnosis of STEMI was confirmed. Median QRS was 98 ms (interquartile range 88-110 ms). RBBB was seen in 44 patients (4.2%) and LBBB in 38 patients (3.7%). Among all 1044 patients 82.4% were treated with percutaneous coronary intervention. During follow-up of median 221 days, 66 patients died. In multivariate analysis, QRS 99-110 ms (hazard ratio (HR) 3.2; 95% confidence interval (CI): 1.2-8.3, p=0.002), QRS >110 ms (HR 4.3; 95% CI: 1.6-11.4, p=0.003) and RBBB (HR 6.5; 95% CI: 2.2-18.8, p=0.001) were associated with all-cause mortality.
Conclusions: In patients with suspected and confirmed STEMI, QRS prolongation >99 ms and RBBB on prehospital ECG are associated with increased risk of death.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-328
- 2017 American College of Cardiology Foundation