Prolonged QT interval in ST-elevation myocardial infarction and mortality: new prognostic scale with QT, Killip and age

被引:18
作者
Rivera-Fernandez, Ricardo [1 ]
Dolores Arias-Verdu, Maria [1 ]
Garcia-Paredes, Teresa [2 ]
Delgado-Rodriguez, Miguel [3 ]
Andres Arboleda-Sanchez, Jose [2 ]
Aguilar-Alonso, Eduardo [4 ]
Quesada-Garcia, Guillermo [1 ]
Vera-Almazan, Antonio [2 ]
机构
[1] Hosp Carlos Haya, Intens Care Unit, Malaga, Spain
[2] Hosp Carlos Haya, Coronary Care Unit, Malaga, Spain
[3] Univ Jaen, CIBERESP, Prevent Med & Publ Hlth, Cabra, Cordoba, Spain
[4] Hosp Infanta Margarita, Intens Care Unit, Ave Gongora S-N, Cabra 14940, Cordoba, Spain
关键词
ICU; mortality; myocardial infarction; outcome and process assessment; severity; PERCUTANEOUS CORONARY INTERVENTION; TIMI RISK SCORE; MANUAL MEASUREMENT; MANAGEMENT; DISPERSION; TRIAL; ALGORITHMS; GUIDELINES; PREDICTOR; ISCHEMIA;
D O I
10.2459/JCM.0000000000000015
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
AimsTo analyze the relation between prolonged QT interval and mortality in patients with ST-elevation myocardial infarction and complementarity with Killip, Thrombolysis in Myocardial Infarction (TIMI) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scales.MethodsA nested cohort case-control study was conducted in a Spanish hospital. The cohort consisted of patients with ST-elevation myocardial infarction admitted between 2008 and 2010 (n=524). The cases were the patients who died (n=38) and the controls (n=81) were a random sample of those who survived (one of every six).ResultsThe corrected QT (QTc) interval of first ECG (prehospital-or-hospital admission) was prolonged in 18 of the 35 patients who died (51.4%) and in 12 of the controls (16.7%; P<0.001). APACHE-II, TIMI and Killip scores were higher in the patients who had died (P<0.001). Mortality with prolonged QTc (19.3%) was 20%, and 4.5% were with normal QTc (80.7%; P<0.001).Logistic regression showed a relation between mortality with prolonged QTc and TIMI [odds ratio (OR) 3.57(1.16-10.97)]. A second model was constructed with APACHE-II and prolonged QTc [OR 6.47(1.77-23.59)]; receiver operating characteristic (ROC) curve area [0.92(0.87-0.97)], and individually, for APACHE-II was 0.88 (0.81-0.95). A new score was constructed: QTc (not prolonged: 0 points, prolonged: 7 points), age (<65 years: 0 points, 65-74 years: 6 points, 75 years: 9 points), Killip (I: 0 points, II-III: 4 points, IV: 17 points). ROC area: 0.88.ConclusionsHospital mortality was higher with prolonged QTc at prehospital-or-hospital admission, given equal Killip, TIMI and APACHE values. Discrimination of Killip, TIMI and APACHE values can be improved with prolonged QTc. Discrimination of a model including Killip, age and prolonged QTc is quite good. We have made a new simple prognostic scale with these variables.
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页码:11 / 19
页数:9
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