NDLI: Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era.

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Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era.

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Year: 2009 Volume: 27 Issue: 1

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Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kontos, Michael C. Roberts, Brett D. Tatum, James L. Roberts, Charlotte S. Jesse, Robert L. Ornato, Joseph P.
Description	Country affiliation: United States Author Affiliation: Kontos MC ( Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Richmond, Virginia, USA. mkontos@mcvh-vcu.edu)
Abstract	BACKGROUND: Studies reporting short-term mortality in patients with myocardial infarction (MI) based on the initial electrocardiogram (ECG) are often limited by requiring an ischemic ECG for inclusion. Because few patients with normal or nonspecific findings were included, outcomes in these patients are less clear, especially in the troponin era. METHODS: Consecutive patients diagnosed as having MI using troponin I (TnI) over a 6-year period were included and classified into 8 mutually exclusive groups based on the initial ECG using standard criteria. Patients were included in only 1 group. The MI size was estimated using multiples of peak creatine kinase-MB (CK-MB), and 30-day mortality rate was assessed. RESULTS: Among 1641 patients with MI, patients with ST elevation represented only 22% of all MIs. Patients with ST elevation had the largest MI size, with 2 of 3 having a peak CK-MB greater than 10 times normal. In contrast, most of the patients representing all the other ECG groups had a peak CK-MB less than 5 times normal, with approximately 1 of 3 having no CK-MB elevation and were diagnosed by TnI elevation alone. Patients could be separated into a high-risk group (ST elevation, ischemia, other, or left bundle-branch block), in which mortality rate exceeded 9% (mean, 14%), and a lower-risk group (prior MI, left ventricular hypertrophy, nonspecific changes, and normal), in which the 30-day mortality rate averaged 6% (P < .001; range, 5.23%-7.1%). CONCLUSIONS: Specific ECG findings other than ischemia portend poor outcomes in patients with MI. Once MI is diagnosed, patients are no longer low risk.
File Format	HTM / HTML
ISSN	07356757
Issue Number	2
Volume Number	27
e-ISSN	15328171
Journal	The American Journal of Emergency Medicine
Language	English
Publisher	Elsevier
Publisher Date	2009-02-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Discipline Medicine Electrocardiography Myocardial Infarction Mortality Aged Biological Markers Blood Chi-square Distribution Creatine Kinase, Mb Form Female Humans Male Middle Aged Diagnosis Risk Assessment Statistics, Nonparametric Troponin I Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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