TY - JOUR
T1 - Can electrocardiographic criteria predict adverse cardiac events and positive cardiac markers?
AU - Blomkalns, Andra L.
AU - Lindsell, Christopher J.
AU - Chandra, Abhinav
AU - Osterlund, Mary E.
AU - Gibler, W. Brian
AU - Pollack, Charles V.
AU - Tiffany, Brian R.
AU - Hollander, Judd E.
AU - Hoekstra, James W.
PY - 2003/3/1
Y1 - 2003/3/1
N2 - Objectives: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG findings, other than those previously identified in higher-risk populations, would be predictive of cardiac outcomes and positive cardiac markers. Methods: This study used data from a prospectively collected, retrospectively analyzed Internet-based data registry of undifferentiated chest pain patients (i*trACS). Logistic regression modeling was performed to determine the ECG findings that were predictive of 1) positive cardiac markers and 2) short-term adverse cardiac events. Results: ST-segment elevation (STE), ST-segment depression (STD), pathological Q-waves (PQW), and T-wave inversion were associated with increased odds of percutaneous coronary intervention or catheterization, myocardial infarction, or coronary artery bypass grafting. The odds of creatine kinase-MB (CK-MB) measuring positive were increased if STE, STD, or PQW were present [odds ratio (OR) 2.495, 2.582, and 1.295, respectively]. A right bundle branch block tended to decrease the odds of CK-MB measuring positive (OR 0.658). A similar pattern of results was observed for troponin I (OR 3.608 for STE, 3.72 for STD, 1.538 for PQW). Troponin T showed an increased odds of measuring positive if any of STE, STD, left bundle branch block, or T-wave inversion were evident (OR 2.313, 2.816, 1.80, and 1.449, respectively). Conclusions: Initial ECG criteria can be used to predict short-term cardiac outcomes and positive cardiac markers. These findings can be important aids in the riskstratification and aggressive treatment regimens of chest pain patients presenting to EDs.
AB - Objectives: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG findings, other than those previously identified in higher-risk populations, would be predictive of cardiac outcomes and positive cardiac markers. Methods: This study used data from a prospectively collected, retrospectively analyzed Internet-based data registry of undifferentiated chest pain patients (i*trACS). Logistic regression modeling was performed to determine the ECG findings that were predictive of 1) positive cardiac markers and 2) short-term adverse cardiac events. Results: ST-segment elevation (STE), ST-segment depression (STD), pathological Q-waves (PQW), and T-wave inversion were associated with increased odds of percutaneous coronary intervention or catheterization, myocardial infarction, or coronary artery bypass grafting. The odds of creatine kinase-MB (CK-MB) measuring positive were increased if STE, STD, or PQW were present [odds ratio (OR) 2.495, 2.582, and 1.295, respectively]. A right bundle branch block tended to decrease the odds of CK-MB measuring positive (OR 0.658). A similar pattern of results was observed for troponin I (OR 3.608 for STE, 3.72 for STD, 1.538 for PQW). Troponin T showed an increased odds of measuring positive if any of STE, STD, left bundle branch block, or T-wave inversion were evident (OR 2.313, 2.816, 1.80, and 1.449, respectively). Conclusions: Initial ECG criteria can be used to predict short-term cardiac outcomes and positive cardiac markers. These findings can be important aids in the riskstratification and aggressive treatment regimens of chest pain patients presenting to EDs.
KW - Cardiac markers
KW - Chest pain
KW - ECG
KW - Risk stratification
UR - http://www.scopus.com/inward/record.url?scp=0037336045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037336045&partnerID=8YFLogxK
U2 - 10.1197/aemj.10.3.205
DO - 10.1197/aemj.10.3.205
M3 - Article
C2 - 12615583
AN - SCOPUS:0037336045
SN - 1069-6563
VL - 10
SP - 205
EP - 210
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 3
ER -