Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008
Background: Diagnosis of acute myocardial infarction (AMI) rests upon clinical, electrocardiographic and biochemical parameters. Previous studies reported AMI patients who present with non-specific ECGs. Objectives: To examine clinical or demographic features of AMI patients presenting...
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| Format: | Article |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2010-08-01
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| Series: | Swiss Medical Weekly |
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| Online Access: | https://www.smw.ch/index.php/smw/article/view/1171 |
| _version_ | 1798003542649208832 |
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| author | SJ François |
| author_facet | SJ François |
| author_sort | SJ François |
| collection | DOAJ |
| description |
Background: Diagnosis of acute myocardial infarction (AMI) rests upon clinical, electrocardiographic and biochemical parameters. Previous studies reported AMI patients who present with non-specific ECGs.
Objectives: To examine clinical or demographic features of AMI patients presenting with or without ECG changes and assess the impact of these ECGs on treatment and outcome.
Methods: Using the AMIS Plus data, patients admitted between 2003 and 2008 with a definite diagnosis of AMI (clinical symptoms, elevated troponin levels) were stratified according to the admission ECG into group 1 with normal/non-specific ECGs and group 2 with ECG changes.
Results: Of 14 957 patients, 1085 (7.3%) belonged to group 1 and 13 872 (92.7%) to group 2. There were no differences between the two groups in age (65.9 yr vs. 65.4 yr), gender (28% female), diabetes (19% vs. 18%), hypertension (61% vs. 59%), family history (35% vs. 33%) or smoking (37% vs. 38%). Dyslipidaemia (62% vs. 56%; p <0.001), history of CAD (39% vs. 35%; p = 0.023) and obesity (BMI >30 kg/m2 [23% vs. 19%; p = 0.003]) were more frequent in group 1 who were admitted longer after symptom onset (280 min vs. 230 min). Patients in group 1 were exposed to less intensive pharmacological and interventional treatments (aspirin [93.6% vs. 95.3%; p = 0.012], clopidogrel [70% vs. 73%; p = 0.046], unfractionated heparin [59% vs. 65%; p <0.001], ACE inhibitors or angiotensin II antagonists [46% vs. 53%; p <0.001]). However, therapy with beta-blockers (72% vs. 70%), statins (75% vs. 76%) and nitrates (59% vs. 57%) did not differ between groups. Patients in group 1 underwent PCI significantly less frequently (69% vs. 77%) with a longer hospital delay (589 min vs. 96 min). No differences were found for reinfarction (both 1.4%) and a cerebrovascular event (0.4% vs. 0.8%). Cardiogenic shock (5% vs. 2%; p <0.001) and mortality during hospitalisation were higher in group 2 (6% vs. 3%; p <0.001). A normal/non-specific ECG on admission was not an independent predictor of in-hospital mortality (OR 0.61; 95% CI 0.34–1.11; p = 0.104).
Conclusions: Despite less intensive treatment, AMI patients who presented with a normal/non-specific ECG developed cardiogenic shock less frequently during their hospitalisation and had a lower crude mortality rate compared to those with ECG changes on admission. Nevertheless, reinfarctions and cerebrovascular events occurred evenly in all AMI patients, regardless of their admission ECG.
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| first_indexed | 2024-04-11T12:10:34Z |
| format | Article |
| id | doaj.art-341a15f2e665488380f42ee75d9c7b4a |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-11T12:10:34Z |
| publishDate | 2010-08-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
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| series | Swiss Medical Weekly |
| spelling | doaj.art-341a15f2e665488380f42ee75d9c7b4a2022-12-22T04:24:38ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972010-08-01140333410.4414/smw.2010.13078Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008SJ François Background: Diagnosis of acute myocardial infarction (AMI) rests upon clinical, electrocardiographic and biochemical parameters. Previous studies reported AMI patients who present with non-specific ECGs. Objectives: To examine clinical or demographic features of AMI patients presenting with or without ECG changes and assess the impact of these ECGs on treatment and outcome. Methods: Using the AMIS Plus data, patients admitted between 2003 and 2008 with a definite diagnosis of AMI (clinical symptoms, elevated troponin levels) were stratified according to the admission ECG into group 1 with normal/non-specific ECGs and group 2 with ECG changes. Results: Of 14 957 patients, 1085 (7.3%) belonged to group 1 and 13 872 (92.7%) to group 2. There were no differences between the two groups in age (65.9 yr vs. 65.4 yr), gender (28% female), diabetes (19% vs. 18%), hypertension (61% vs. 59%), family history (35% vs. 33%) or smoking (37% vs. 38%). Dyslipidaemia (62% vs. 56%; p <0.001), history of CAD (39% vs. 35%; p = 0.023) and obesity (BMI >30 kg/m2 [23% vs. 19%; p = 0.003]) were more frequent in group 1 who were admitted longer after symptom onset (280 min vs. 230 min). Patients in group 1 were exposed to less intensive pharmacological and interventional treatments (aspirin [93.6% vs. 95.3%; p = 0.012], clopidogrel [70% vs. 73%; p = 0.046], unfractionated heparin [59% vs. 65%; p <0.001], ACE inhibitors or angiotensin II antagonists [46% vs. 53%; p <0.001]). However, therapy with beta-blockers (72% vs. 70%), statins (75% vs. 76%) and nitrates (59% vs. 57%) did not differ between groups. Patients in group 1 underwent PCI significantly less frequently (69% vs. 77%) with a longer hospital delay (589 min vs. 96 min). No differences were found for reinfarction (both 1.4%) and a cerebrovascular event (0.4% vs. 0.8%). Cardiogenic shock (5% vs. 2%; p <0.001) and mortality during hospitalisation were higher in group 2 (6% vs. 3%; p <0.001). A normal/non-specific ECG on admission was not an independent predictor of in-hospital mortality (OR 0.61; 95% CI 0.34–1.11; p = 0.104). Conclusions: Despite less intensive treatment, AMI patients who presented with a normal/non-specific ECG developed cardiogenic shock less frequently during their hospitalisation and had a lower crude mortality rate compared to those with ECG changes on admission. Nevertheless, reinfarctions and cerebrovascular events occurred evenly in all AMI patients, regardless of their admission ECG. https://www.smw.ch/index.php/smw/article/view/1171acute myocardial infarctionelectrocardiogramoutcomeTreatment |
| spellingShingle | SJ François Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 Swiss Medical Weekly acute myocardial infarction electrocardiogram outcome Treatment |
| title | Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 |
| title_full | Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 |
| title_fullStr | Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 |
| title_full_unstemmed | Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 |
| title_short | Impact of a normal or non-specific admission ECG on the treatment and early outcome of patients with myocardial infarction in Swiss hospitals between 2003 and 2008 |
| title_sort | impact of a normal or non specific admission ecg on the treatment and early outcome of patients with myocardial infarction in swiss hospitals between 2003 and 2008 |
| topic | acute myocardial infarction electrocardiogram outcome Treatment |
| url | https://www.smw.ch/index.php/smw/article/view/1171 |
| work_keys_str_mv | AT sjfrancois impactofanormalornonspecificadmissionecgonthetreatmentandearlyoutcomeofpatientswithmyocardialinfarctioninswisshospitalsbetween2003and2008 |