Nonspecific electrocardiographic abnormalities are associated with increased length of stay and adverse cardiac outcomes in prehospital chest pain.
Nonspecific electrocardiographic abnormalities are associated with increased length of stay and adverse cardiac outcomes in prehospital chest pain.
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DOI：
10.1016/j.hrtlng.2018.09.001
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Al-Zaiti S
中科院分区：
文献类型：
--
作者：
Rivero D;Alhamaydeh M;Faramand Z;Alrawashdeh M;Martin-Gill C;Callaway C;Drew B;Al-Zaiti S
非特异性 ST-T 复极 (NST) 异常会因通常与急性心肌缺血无关的原因改变 ST 段，这可能导致误诊或不适当的治疗。我们试图确定胸痛患者 NST 模式的患病率，并评估这些模式与胸痛的最终病因和住院过程的相关性。这是一项前瞻性观察性研究，纳入了来自美国三所三级医院的连续院前胸痛患者。两名对临床数据不知情的独立评审员审核了院前 12 导联心电图是否存在 NST 模式（即右束支传导阻滞或左束支传导阻滞、左心室肥大伴应变模式、心室起搏、心室节律或粗心房颤动）。主要结局是 30 天主要不良心脏事件 (MACE)，定义为心脏骤停、急性心力衰竭、出院后梗塞或全因死亡。最终样本包括 750 名患者（年龄 59±17 岁，58% 男性）。共有 40 名患者 (5.3%) 经历了 30-MACE，131 名患者 (17.5%) 出现 NST 模式。 NST 模式的存在是 30 天 MACE 的独立多变量预测因子（9.9% vs. 4.4%，OR = 2.2 [95% CI = 1.1–4.5]）。具有 NST 模式的患者中位住院时间增加（1.0 [IQR 0.5–3] vs. 2.0 [IQR 1–4] 天，p<0.05），与胸痛的病因无关。六名胸痛患者的院前心电图显示 NST 模式，这种模式与住院时间延长和不良心脏结局相关，表明需要对此类患者采取预防措施和密切随访。
Nonspecific ST-T repolarization (NST) abnormalities alter the ST-segment for reasons often unrelated to acute myocardial ischemia, which could contribute to misdiagnosis or inappropriate treatment. We sought to define the prevalence of NST patterns in patients with chest pain and evaluate how such patterns correlate with the eventual etiology of chest pain and course of hospitalization. This was a prospective observational study that included consecutive prehospital chest pain patients from three tertiary care hospitals in the U.S. Two independent reviewers blinded from clinical data audited the prehospital 12-lead ECG for the presence or absence of NST patterns (i.e., right or left bundle branch block, left ventricular hypertrophy with strain pattern, ventricular pacing, ventricular rhythm, or coarse atrial fibrillation). The primary outcome was 30-day major adverse cardiac events (MACE) defined as cardiac arrest, acute heart failure, post-discharge infarction, or all-cause death. The final sample included 750 patients (age 59±17, 58% males). A total of 40 patients (5.3%) experienced 30-MACE and 131 (17.5%) had NST patterns. The presence of NST patterns was an independent multivariate predictor of 30-day MACE (9.9% vs. 4.4%, OR = 2.2 [95% CI = 1.1–4.5]. Patients with NST patterns had increased median length of stay (1.0 [IQR 0.5–3] vs. 2.0 [IQR 1–4] days, p<0.05) independent of the etiology of chest pain. One in six prehospital ECGs of patients with chest pain has NST patterns. This pattern is associated with increased length of stay and adverse cardiac outcomes, suggesting the need of preventive measures and close follow up in such patients.
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影响因子：
24
作者：
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通讯作者：
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影响因子：
1.3
作者：
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影响因子：
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作者：
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影响因子：
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作者：
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DOI：
10.1161/circoutcomes.114.001384
发表时间：
2015-03
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Mahler SA;Riley RF;Hiestand BC;Russell GB;Hoekstra JW;Lefebvre CW;Nicks BA;Cline DM;Askew KL;Elliott SB;Herrington DM;Burke GL;Miller CD
通讯作者：
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