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Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction

2018; Elsevier BV; Volume: 277; Linguagem: Inglês

10.1016/j.ijcard.2018.09.040

1874-1754

Ivo Strebel, Raphael Twerenbold, Desiree Wussler, Jasper Boeddinghaus, Thomas Nestelberger, Jeanne du Fay de Lavallaz, Roger Abächerli, Patrick Maechler, Diego Mannhart, Nikola Kozhuharov, María Rubini Giménez, Karin Wildi, Lorraine Sazgary, Zaid Sabti, Christian Puelacher, Patrick Badertscher, Dagmar I. Keller, Òscar Miró, Carolina Fuenzalida, Sofía Calderón, Francisco Javier Martín‐Sánchez, Sergio Lopez Iglesias, Stefan Osswald, Christian Mueller, Tobias Reichlin,

Cardiac Imaging and Diagnostics

Background The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization–repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis). Methods We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years. Results NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001). Conclusion In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.