title: Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction.
abstract: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF) according to the combination of ischemia severity (Sclarovsky-Birnbaum grades) and acuteness (Anderson-Wilkins scores) in the pre-hospital electrocardiogram (ECG).
  
  
  
  In a predefined secondary analysis of a prospective study, the severity and acuteness scores were performed on the pre-hospital ECG. Patients were assessed with respect to 4 classifications which were not mutually exclusive: severe ischemia (+SI) or non-severe ischemia (-SI) and acute ischemia (+AI) or non-acute ischemia (-AI). LVF was assessed by global longitudinal strain (GLS) within 48hours of admission. Adjusted linear regression investigated the association of system delay with GLS in each group.
  
  
  
  In total 262 patients were eligible for analysis of the ECG, which resulted in 42 (16%) with (+SI, -AI), 110 (42%) with (-SI, -AI), 90 (34%) with (-SI, +AI), and 20 (8%) patients with (+SI, +AI). Although system delay did not differ between groups, patients with severe and non-acute ischemia had the most impaired LVF. System delay correlated weakly with GLS in the entire population (r=0.133, p=0.031), and well with GLS in the (+SI, +AI) group (r=0.456, p=0.04), while there was no correlation in the other groups. By adjusted analysis, system delay predicted impaired GLS only in the (+SI, +AI) group (β=0.578, p=0.002).
  
  
  
  Pre-hospital risk stratification by ECG identifies patients with acute and severe ischemia who are at increased risk for reduced ventricular function (assessed by GLS) after STEMI. Optimizing reperfusion delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Copenhagen University Hospital, Nykøbing F, Denmark. Electronic address: yfakhri@gmail.com.
authors.forename: Yama
authors.initials: Y
authors.lastname: Fakhri
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Ersbøll
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Anesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hesselfeldt
authors.affiliation: Department of Anesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Steinmetz
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Sejersten
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.affiliation: Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Nykøbing F, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; University Clinic Hamburg-Eppendorf, The Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Zealand University Hospital, Denmark.
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D015984:Causality; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Ischemia Acuteness; Ischemia Severity; Prehospital ECG; STEMI