title: Use of ischemic ECG patterns for risk stratification in intermediate-risk patients with acute PE.
abstract: BACKGROUND
  European recommendations on the management of acute pulmonary embolism (APE) divide patients into 3 risk categories: high, intermediate, and low. Mortality has previously been estimated at 3% to 15% in the intermediate group. The aim of this study was to use a new metric "ischemic electrocardiographic (ECG) patterns" to more precisely estimate the risk (complications or death) of APE patients identified as "intermediate risk" by current European Society of Cardiology (ESC) criteria.
  
  
  METHODS
  The study group consisted of 500 consecutive patients (290 females), with a mean age 66.3 ± 15.2 years, and 245 (72.8%) patients were initially classified as intermediate risk. Four ischemic ECG patterns were studied: (i) ST-segment ischemic pattern (STIP), (ii) global ischemic pattern (GIP), (iii) negative T wave pattern, and (iv) control group consisting of patients with no ischemic changes.
  
  
  RESULTS
  Predictors of death in univariate analysis included elevated troponin concentration (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.28-169; P = 0.02]) and ischemic ECG patterns: STIP (OR, 6.3; 95% CI, 1.6-46.0; P = 0.007). Patients with right ventricular dysfunction (RVD) who were STIP (+) experienced significantly higher mortality rate compared to RVD patients who were STIP(-) (11.4% vs 1.6%; OR, 7.26; 95% CI, 1.82-52.8; P = 0.004). In patients with STIP (+) as compared to STIP (-), rate of death (OR, 6.35; P = 0.007) and rate of complications (OR, 4.19; P = 0.002) were significantly higher. Neither presence of negative T-waves nor GIP pattern was associated with a worse prognosis.
  
  
  CONCLUSIONS
  In patients with APE, an ischemic ECG pattern on hospital admission, when identified in addition to classic risk markers, is an independent risk factor for worse in-hospital outcomes.
authors.affiliation: Department of Cardiology, Specialistic Hospital, Gorlice, Poland. Electronic address: kukla_piotr@poczta.onet.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kukla
authors.affiliation: Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: William F
authors.initials: WF
authors.lastname: McIntyre
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Szczeklik Hospital, Department of Cardiology, Tarnow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Krupa
authors.affiliation: Department of Cardiology, Dietl `s Hospital, Cracow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Mirek-Bryniarska
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzębski
authors.affiliation: First Department of Internal Medicine, Dietl `s Hospital, Cracow, Poland.
authors.forename: Krzysztof L
authors.initials: KL
authors.lastname: Bryniarski
authors.affiliation: Polpharma Commercial Office Department Management, Warsaw, Poland.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Zajchowski
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.affiliation: Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016022:Case-Control Studies; D015331:Cohort Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D055815:Young Adult
chemical_list: D020107:Troponin T