title: The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion.
abstract: Many recently published studies established the admission electrocardiogram as an excellent source of prognostic information in patients presenting with acute myocardial infarction. Using our search criteria, we identified a large number of articles but selected only the most relevant in each category. The best predictors of increased short-term mortality are ventricular tachycardia (odds ratio [OR] 6.1, 95% CI 4.6-8.3), ST-segment deviations (OR 5.1, 95% CI 4.6-8.3), high-degree atrioventricular block (OR 5.1, 95% CI 2.1-11.9), and long QRS duration (OR 4.2, 95% CI 1.8-10.4). For increased long-term mortality, the best predictors were ST-segment depression (OR 5.7, 95% CI 2.8-11.6), ST-segment elevation (OR 3.3, 95% CI 2.1-5.1), and left bundle-branch block (OR 2.8, 95% CI 1.8-4.3). In addition, our review discusses electrocardiographic markers of poor outcome that were not independent risk factors on multivariate analysis, conflicting findings, and knowledge gaps that can help plan future research efforts.
authors.affiliation: University of Michigan Medical Center, Ann Arbor, MI, USA. mirceapetrina@hotmail.com
authors.forename: Mircea
authors.initials: M
authors.lastname: Petrina
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology; D002037:Bundle-Branch Block / Q000453:epidemiology; D015897:Comorbidity; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D015912:Thrombolytic Therapy