Document Detail

Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era.
MedLine Citation:
PMID:  19371520     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Studies reporting short-term mortality in patients with myocardial infarction (MI) based on the initial electrocardiogram (ECG) are often limited by requiring an ischemic ECG for inclusion. Because few patients with normal or nonspecific findings were included, outcomes in these patients are less clear, especially in the troponin era. METHODS: Consecutive patients diagnosed as having MI using troponin I (TnI) over a 6-year period were included and classified into 8 mutually exclusive groups based on the initial ECG using standard criteria. Patients were included in only 1 group. The MI size was estimated using multiples of peak creatine kinase-MB (CK-MB), and 30-day mortality rate was assessed. RESULTS: Among 1641 patients with MI, patients with ST elevation represented only 22% of all MIs. Patients with ST elevation had the largest MI size, with 2 of 3 having a peak CK-MB greater than 10 times normal. In contrast, most of the patients representing all the other ECG groups had a peak CK-MB less than 5 times normal, with approximately 1 of 3 having no CK-MB elevation and were diagnosed by TnI elevation alone. Patients could be separated into a high-risk group (ST elevation, ischemia, other, or left bundle-branch block), in which mortality rate exceeded 9% (mean, 14%), and a lower-risk group (prior MI, left ventricular hypertrophy, nonspecific changes, and normal), in which the 30-day mortality rate averaged 6% (P < .001; range, 5.23%-7.1%). CONCLUSIONS: Specific ECG findings other than ischemia portend poor outcomes in patients with MI. Once MI is diagnosed, patients are no longer low risk.
Michael C Kontos; Brett D Roberts; James L Tatum; Charlotte S Roberts; Robert L Jesse; Joseph P Ornato
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  27     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-04-17     Completed Date:  2009-05-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  146-52     Citation Subset:  IM    
Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Richmond, Virginia, USA.
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MeSH Terms
Biological Markers / blood
Chi-Square Distribution
Creatine Kinase, MB Form / blood
Middle Aged
Myocardial Infarction / diagnosis,  mortality*
Risk Assessment
Statistics, Nonparametric
Troponin I / blood
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; EC Kinase, MB Form

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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