title: Prognostic implications of prominent R wave in electrocardiographic leads V1 or V2 in patients with acute coronary syndrome.
abstract: Although the adverse prognosis of Q-waves on electrocardiogram (ECG) has been demonstrated, the prognostic significance of prominent R wave (PRW) in V1 or V2 across a broad spectrum of acute coronary syndrome (ACS) has not been specifically studied. In the Global Registry of Acute Coronary Events (GRACE) and the Canadian ACS Registry I ECG substudies, admission ECGs were analyzed in an independent core ECG laboratory. PRW was defined as R wave >40 to 50 ms in V1 or V2, R/S ≥1 in V1, or R/S ≥1.5 in V2. Among 11,895 patients with ACS, 495 (4.2%) had PRW; they were less likely to have a history of hypertension or heart failure and had lower GRACE risk scores, but a higher incidence of ST-segment depression (all p ≤0.001). Patients with PRW had similar rates of in-hospital death (2.8% vs 4.1%, respectively, p = 0.15) but lower rates of in-hospital heart failure (8.5% vs 15.2%, respectively, p = 0.02) and 6-month mortality (4.6% vs 8.4%, respectively, p = 0.004). In multivariable analyses, PRW was not a significant independent predictor of in-hospital mortality (adjusted odds ratio = 0.99, 95% confidence interval 0.55 to 1.8) or 6-month mortality (adjusted odds ratio = 0.70, 95% confidence interval 0.43 to 1.15). Among 4,418 patients who underwent coronary angiography, those with PRW had a higher prevalence of left circumflex artery disease (62.5% vs 49.5%, respectively, p = 0.01). In conclusion, across the broad spectrum of patients with ACS, PRW provides no significant additional prognostic utility beyond comprehensive risk assessment using the GRACE risk score. PRW is more frequently associated with left circumflex artery disease.
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Alqarawi
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada; Canadian Heart Research Centre, Toronto, Canada.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.affiliation: Hôpital Maisonneuve-Rosemont, Universite de Montreal, Montreal, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Constance
authors.affiliation: Vancouver General Hospital, Vancouver, Canada.
authors.forename: Anthony Y
authors.initials: AY
authors.lastname: Fung
authors.affiliation: Lakeridge Health Oshawa, Oshawa, Canada.
authors.forename: James Y
authors.initials: JY
authors.lastname: Cha
authors.affiliation: Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Canada.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gosselin
authors.affiliation: Concord Hospital, University of Sydney, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.affiliation: Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada. Electronic address: yana@smh.ca.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis