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Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes.
Int J Cardiol. 2015; 190:34-9.IJ

Abstract

PURPOSE

To examine the prognostic significance of low QRS voltage in a large contemporary cohort of patients with a broad spectrum of acute coronary syndromes (ACS).

METHODS

12409 patients with STEMI or NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and Canadian ACS I registries were stratified based on the presence of low QRS voltage (<0.5 mV in all limb leads and <1.0 mV in all precordial leads) on the admission ECG. We performed multivariable logistic regression to assess the independent association between low voltage and in-hospital and 6-month mortality, and tested for its interaction with ST-segment deviation for these outcomes.

RESULTS

Patients with low voltage (3.2%) had higher GRACE risk scores, rates of prior myocardial infarction, and pathological Q waves, with less prevalent ST-segment deviation and ST-segment depression. They had worse left ventricular function and higher unadjusted rates of in-hospital and 6-month mortality. After adjustment for established prognosticators in the GRACE risk models in multivariable analysis, low voltage was independently associated with higher in-hospital mortality (adjusted OR 1.77, 95% CI 1.13-2.78, P=0.013) and mortality/re-infarction (adjusted OR 1.42, 95% CI 1.05-1.93, P=0.023), but not 6-month mortality (adjusted OR 1.25, 95% CI 0.85-1.84, P=0.27). There was no significant interaction between low voltage and ST-segment deviation for any endpoint (interaction P>0.10 for all endpoints).

CONCLUSIONS

Low QRS voltage was associated with previous myocardial infarction and adverse hemodynamic variables at presentation. After adjusting for other prognosticators, low voltage independently predicted higher in-hospital mortality. This increased risk was not modulated by concomitant ST-segment deviation.

Authors+Show Affiliations

Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada.University of Toronto, Toronto, ON, Canada.Canadian Heart Research Centre, Toronto, ON, Canada.Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.Coronary Care Unit, Concord Hospital, Sydney, Australia.DHU FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, INSERM, U1148 Paris, France.University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada.Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: yana@smh.ca.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25912116

Citation

Tan, Nigel S., et al. "Prognostic Significance of Low QRS Voltage On the Admission Electrocardiogram in Acute Coronary Syndromes." International Journal of Cardiology, vol. 190, 2015, pp. 34-9.
Tan NS, Goodman SG, Yan RT, et al. Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes. Int J Cardiol. 2015;190:34-9.
Tan, N. S., Goodman, S. G., Yan, R. T., Tan, M. K., Fox, K. A., Gore, J. M., Brieger, D., Steg, P. G., Langer, A., & Yan, A. T. (2015). Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes. International Journal of Cardiology, 190, 34-9. https://doi.org/10.1016/j.ijcard.2015.04.085
Tan NS, et al. Prognostic Significance of Low QRS Voltage On the Admission Electrocardiogram in Acute Coronary Syndromes. Int J Cardiol. 2015;190:34-9. PubMed PMID: 25912116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes. AU - Tan,Nigel S, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Tan,Mary K, AU - Fox,Keith A A, AU - Gore,Joel M, AU - Brieger,David, AU - Steg,Ph Gabriel, AU - Langer,Anatoly, AU - Yan,Andrew T, AU - ,, Y1 - 2015/04/14/ PY - 2015/03/03/received PY - 2015/04/05/revised PY - 2015/04/12/accepted PY - 2015/4/28/entrez PY - 2015/4/29/pubmed PY - 2016/3/2/medline KW - Acute coronary syndrome KW - Electrocardiogram KW - Low QRS voltage KW - Prognosis SP - 34 EP - 9 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 190 N2 - PURPOSE: To examine the prognostic significance of low QRS voltage in a large contemporary cohort of patients with a broad spectrum of acute coronary syndromes (ACS). METHODS: 12409 patients with STEMI or NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and Canadian ACS I registries were stratified based on the presence of low QRS voltage (<0.5 mV in all limb leads and <1.0 mV in all precordial leads) on the admission ECG. We performed multivariable logistic regression to assess the independent association between low voltage and in-hospital and 6-month mortality, and tested for its interaction with ST-segment deviation for these outcomes. RESULTS: Patients with low voltage (3.2%) had higher GRACE risk scores, rates of prior myocardial infarction, and pathological Q waves, with less prevalent ST-segment deviation and ST-segment depression. They had worse left ventricular function and higher unadjusted rates of in-hospital and 6-month mortality. After adjustment for established prognosticators in the GRACE risk models in multivariable analysis, low voltage was independently associated with higher in-hospital mortality (adjusted OR 1.77, 95% CI 1.13-2.78, P=0.013) and mortality/re-infarction (adjusted OR 1.42, 95% CI 1.05-1.93, P=0.023), but not 6-month mortality (adjusted OR 1.25, 95% CI 0.85-1.84, P=0.27). There was no significant interaction between low voltage and ST-segment deviation for any endpoint (interaction P>0.10 for all endpoints). CONCLUSIONS: Low QRS voltage was associated with previous myocardial infarction and adverse hemodynamic variables at presentation. After adjusting for other prognosticators, low voltage independently predicted higher in-hospital mortality. This increased risk was not modulated by concomitant ST-segment deviation. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/25912116/Prognostic_significance_of_low_QRS_voltage_on_the_admission_electrocardiogram_in_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(15)00807-4 DB - PRIME DP - Unbound Medicine ER -