title: Prognostic significance of the distortion of terminal portion of QRS complex on admission electrocardiogram in ST segment elevation myocardial infarction.
abstract: BACKGROUND
  ECG on admission has been used in predicting prognosis and risk stratification in ST segment elevation acute myocardial infarction (STEMI).
  
  
  OBJECTIVE
  To analyze the admission ECG in STEMI based on abnormality observed in terminal portion of QRS and its correlation to hospital mortality.
  
  
  METHODS
  160 consecutive patients of STEMI were classified into subjects without (Group I) and with distortion of terminal QRS (Group II), Pattern A--Emergence of J point at ≥50% of the R wave amplitude in leads with qR configuration or Pattern B--Absence of the S waves, in leads with Rs configuration in two consecutive leads.
  
  
  RESULTS
  Out of 160 patients of STEMI, 69 (43.1%) had distortion of QRS. There were 13 deaths (8.1%). Hospital mortality was found to be significantly more in subjects with distortion than those without (15.9% V/S 2.1%, p < 0.001). Patients with QRS distortion tended to have larger infarction as assessed by Killip class on admission (p < 0.05), anterior location of MI (p < 0.01) and presence of significant Q waves in leads with ST segment elevation (p < 0.0001). With multiple logistic regression analysis using hospital mortality as a dependent variable and all studied risk factors as independent variables, QRS distortion on admission ECG was the only variable found to be statistically significant (Adjusted OR = 7.161, p < 0.05).
  
  
  CONCLUSIONS
  ECG on admission is a simple, cheap, universally available investigation that can predict the short term prognosis in STEMI and would help in deciding which patients should go for other myocardial revascularization procedures.
authors.affiliation: Department of Medicine, Government Medical College, Aurangabad 431001, Maharashtra, India. Electronic address: mulay.dv@gmail.com.
authors.forename: Dnyaneshwar V
authors.initials: DV
authors.lastname: Mulay
authors.affiliation: Department of Medicine, Government Medical College, Aurangabad 431001, Maharashtra, India.
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Mukhedkar
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
keywords: AMI; ECG changes; Prognosis