Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction-Reference-Cited by-同舟云学术

Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction

Published:2020-12-01 Issue:8 Volume:9 Page:857-868
ISSN:2048-8734
Container-title:European Heart Journal. Acute Cardiovascular Care
language:en
Short-container-title:

Author:

Grimm Karin¹²³,Twerenbold Raphael¹²,Abaecherli Roger¹²⁴,Boeddinghaus Jasper¹²³,Nestelberger Thomas¹²,Koechlin Luca¹²,Troester Valentina¹²³,Bourtzou Anna¹²,Keller Dagmar I⁵,Geigy Nicolas⁶,Kozhuharov Nikola¹,Wussler Desiree¹³,Wildi Karin¹²,Hillinger Petra¹,Rubini Giménez Maria¹²⁷⁸,Strebel Ivo¹,Badertscher Patrick¹²,Puelacher Christian¹²³,du Fay de Lavallaz Jeanne¹²,Osswald Luca¹,Morawiec Beata⁹,Kawecki Damian⁹,Miró Òscar¹⁰,Kühne Michael¹,Reichlin Tobias¹²¹¹,Mueller Christian¹²

Affiliation:

1. Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland

2. Global Research on acute conditions Team (GREAT Network), Italy

3. Department of Internal Medicine, University Hospital Basel, Switzerland

4. Institute for Medical Engineering, Lucerne University of Applied Sciences and Arts, Switzerland

5. Emergency Department, University Hospital Zurich, Switzerland

6. Emergency Department, Kantonsspital Baselland, Switzerland

7. Servicio de Urgencias y Pneumologia, Hospital del Mar – Institut Municipal d’Investigació Mèdica, Spain

8. Leipzig Heart Center, Leipzig, Germany

9. 2nd Department of Cardiology, Zabrze, Medical University of Silesia in Katowice, Poland

10. Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain

11. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

Abstract

Background: Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown. Methods: We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up. Results: Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69–0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49–0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin (p<0.001) as well as clinical judgment at 90 min (p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality. Conclusions: The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information.

Funder

schweizerischer nationalfonds zur férderung der wissenschaftlichen forschung

schweizerische herzstiftung

cardiovascular research foundation

universität basel

Universitätsspital Basel

8sense

abbott laboratories

beckman coulter foundation

BRAHMS

Nanosphere

roche

Schiller

siemens

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

Link

http://journals.sagepub.com/doi/pdf/10.1177/2048872619853579

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