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Int J Cardiol. 2015;190:34-9. doi: 10.1016/j.ijcard.2015.04.085. Epub 2015 Apr 14.

Prognostic significance of low QRS voltage on the admission electrocardiogram in acute coronary syndromes.

Author information

1
Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
2
Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada.
3
University of Toronto, Toronto, ON, Canada.
4
Canadian Heart Research Centre, Toronto, ON, Canada.
5
Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
6
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
7
Coronary Care Unit, Concord Hospital, Sydney, Australia.
8
DHU FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, INSERM, U1148 Paris, France.
9
University of Toronto, Toronto, ON, Canada; Canadian Heart Research Centre, Toronto, ON, Canada.
10
Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: yana@smh.ca.

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.

KEYWORDS:

Acute coronary syndrome; Electrocardiogram; Low QRS voltage; Prognosis

PMID:
25912116
DOI:
10.1016/j.ijcard.2015.04.085
[Indexed for MEDLINE]

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