Electrocardiographic differentiation between acute pulmonary embolism and non-ST elevation acute coronary syndromes at the bedside.
BACKGROUND
Clinical picture of acute pulmonary embolism (APE), with wide range of electrocardiographic (ECG) abnormalities can mimic acute coronary syndromes.


OBJECTIVE
Assessment of standard 12-lead ECG usefulness in differentiation at the bedside between APE and non-ST elevation acute coronary syndrome (NSTE-ACS).


METHODS
Retrospective analysis of 143 patients: 98 consecutive patients (mean age 63.4 +/- 19.4 year, 45 M) with APE and 45 consecutive patients (mean age 72.8 +/- 10.8 year, 44 M) with NSTE-ACS. Standard ECGs recorded on admission were compared in separated groups.


RESULTS
Right bundle branch block (RBBB) and S(1)S(2)S(3) or S(1)Q(3)T(3) pattern were found in similar frequency in both groups (10 [11%] APE patients vs 6 [14%] NSTE-ACS patients, 27 [28%] patients vs 7 [16%] patients, respectively, NS). Negative T waves in leads V(1-3) together with negative T waves in inferior wall leads II, III, aVF (OR 1.3 [1.14-1.68]) significantly indicated APE with a positive predictive value of 85% and specificity of 87%. However, counterclockwise axis rotation (OR 4.57 [2.74-7.61]), ventricular premature beats (OR 2.60 [1.60-4.19]), ST depression in leads V(1-3) (OR 2.25 [1.43-3.56]), and negative T waves in leads V(5-6) (OR 2.08 [1.31-3.29]) significantly predicted NSTE-ACS.


CONCLUSIONS
RBBB, S(1)S(2)S(3), or S(1)Q(3)T(3) pattern described as characteristic for APE were not helpful in the differentiation between APE and NSTE-ACS in studied group. Coexistence of negative T waves in precordial leads V(1-3) and inferior wall leads may suggest APE diagnosis.
Department of Internal Medicine and Cardiology of Warsaw Medical University, Poland.
Krzysztof
K
Jankowski
Maciej
M
Kostrubiec
Patrycja
P
Ozdowska
Blanka
B
Milanowska-Puncewicz
Szymon
S
Pacho
Justyna
J
Pedowska-Włoszek
Anna
A
Kaczyńska
Andrzej
A
Labyk
Anna
A
Hrynkiewicz
Piotr
P
Pruszczyk
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D003327:Coronary Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity