Coskun Abuzer, Demirci Burak, Alkan Mehmet Oktay, Gundogan Selman, Eren Sevki Hakan
Department of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul 34200, Turkey.
Department of Emergency Medicine, Faculty of Medicine, Gaziantep University, Gaziantep 27410, Turkey.
Medicina (Kaunas). 2024 Dec 11;60(12):2038. doi: 10.3390/medicina60122038.
: In patients with acute coronary syndrome, electrocardiographic parameters, including ST elevation in lead aVR (aVR-STE), ST depression (aVR-STD), and QTc prolongation, are crucial. This study aims to show the predictive value of a longer QTc in emergency department patients with acute coronary syndrome and ≥1 mm ST elevation or depression in the aVR lead in electrocardiography. : A retrospective analysis was conducted on 1273 patients admitted to the emergency department with a preliminary diagnosis of acute coronary syndrome between 2020 and 2023. ST depression, ST elevation, and QTc were documented in the electrocardiography of the patients. Furthermore, acute coronary syndrome subtypes were identified. Basic demographic characteristics, complications, concomitant diseases, and 30-day and 180-day mortality data were collected. : The mean age of 1273 patients included in the study was 63.23 (10.06) years and 548 (43%) were female ( = 0.030). In the aVR-STE group, the QTc was 483.31 (33.96) ms in STEMI, 474.98 (26.21) ms in NSTEMI, and 505.60 (9.76) ms in those with mortality ( < 0.001). In the aVR-STD group, the QTc was 465.10 (42.63) ms in STEMI, 457.52 (39.52) ms in NSTEMI, and 508.73 (4.71) ms in those with mortality ( < 0.001). The total 30-day mortality was 129 (10.1%) and 180-day mortality was 181 (14.2%) ( < 0.001). In the uni-multivariable regression analysis performed for both change in aVR derivation and mortality, it was determined that prolonging QTc could be a predictive value for acute coronary syndrome ( < 0.001). We found sensitivity at 99.7% and specificity at 99.2% in predicting mortality in patients with prolonged QTc (AUC: 0.983, 95% CI: 0.974-0.993, < 0.001). : In patients with acute coronary syndrome, a prolonged QTc is an independent predictor of short- and long-term mortality in alterations in aVR derivation.
在急性冠状动脉综合征患者中，心电图参数至关重要，包括aVR导联ST段抬高（aVR-STE）、ST段压低（aVR-STD）和QTc延长。本研究旨在揭示QTc延长对急诊科急性冠状动脉综合征且心电图aVR导联ST段抬高或压低≥1mm患者的预测价值。：对2020年至2023年间急诊科收治的初步诊断为急性冠状动脉综合征的1273例患者进行回顾性分析。记录患者心电图中的ST段压低、ST段抬高和QTc。此外，确定急性冠状动脉综合征的亚型。收集基本人口统计学特征、并发症、合并疾病以及30天和180天死亡率数据。：纳入研究的1273例患者的平均年龄为63.23（10.06）岁，548例（43%）为女性（P = 0.030）。在aVR-STE组中，ST段抬高型心肌梗死（STEMI）患者的QTc为483.31（33.96）毫秒，非ST段抬高型心肌梗死（NSTEMI）患者为474.98（26.21）毫秒，死亡患者为505.60（9.76）毫秒（P < 0.001）。在aVR-STD组中，STEMI患者的QTc为465.10（42.63）毫秒，NSTEMI患者为457.52（39.52）毫秒，死亡患者为508.73（4.71）毫秒（P < 0.001）。30天总死亡率为129例（10.1%），180天死亡率为181例（14.2%）（P < 0.00一）。在针对aVR导联变化和死亡率进行的单变量-多变量回归分析中，确定QTc延长可能对急性冠状动脉综合征具有预测价值（P < 0.001）。我们发现QTc延长患者预测死亡率的敏感性为99.7%，特异性为99.2%（AUC：0.983，95%CI：0.974 - 0.993，P < 0.001）。：在急性冠状动脉综合征患者中，QTc延长是aVR导联变化中短期和长期死亡率的独立预测因素。
