The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion.
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.
Petrina
Mircea
M
University of Michigan Medical Center, Ann Arbor, MI, USA. mirceapetrina@hotmail.com
Goodman
Shaun G
SG
Eagle
Kim A
KA
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