Prevalence and predictive value of ECG findings in acute extremity ischemia.
OBJECTIVE
To determine the prevalence and predictive value of ECG findings in patients treated surgically for acute extremity ischemia.


METHODS
Retrospective study with follow-up for one month.


METHODS
Tampere University Hospital, Jyväskylä Central Hospital.


METHODS
114 patients with acute extremity ischemia treated surgically.


METHODS
Emergency thromboembolectomy was performed to all patients.


METHODS
ECGs, taken preoperatively at the emergency department, were analysed according to the Minnesota code. Death was regarded as the endpoint of the study.


RESULTS
ST-J depression (60.5%) and T-wave inversion (71.9%) were the most common single findings. The ECG was considered suggestive of ischemic heart disease in 64.0% of patients. The prevalence of atrial fibrillation was 37.7%. Atrial fibrillation was found in 25.0% of patients with acute thrombotic occlusion and in 43.6% of patients with embolic occlusion (chi 2 = 3.6, df = 1, p = 0.057). The ECG was suggestive of ischemic heart disease in 87.5% of patients who died within a month compared to 60.2% in those still alive (chi 2 = 4.4, df = 1, p = 0.034). In logistic regression analysis atrial fibrillation was found to increase the risk of mortality (B = 0.93, df = 1, p = 0.002); odds ratio 2.6 (95% CI 1.4-4.7).


CONCLUSIONS
Most patients with acute extremity ischemia had significant ECG findings with low prevalence of AF reflecting increased ratio of thrombotic occlusions. AF and ECG suggestive of ischemic heart disease were also associated to poor short-term prognosis. We think that acute thrombosis should be suspected in most patients with acute extremity ischemia.
Department of Surgery and Clinical Medicine, Tampere University, Finland.
P
P
Kuukasjärvi
H
H
Riekkinen
J P
JP
Salenius
K
K
Vattulainen
S
S
Lindholm
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D004562:Electrocardiography; D004617:Embolism / Q000150:complications / Q000175:diagnosis; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis