Early/Subtle Electrocardiography Features of Acute Coronary Syndrome and ST-Segment Elevation Myocardial Infarction

Gunaseelan, R; Sasikumar, M; Nithya, B; Aswin, K; Ezhilkugan, G; Anuusha, S S; Balamurugan, N; Vivekanandan, Muthupillai

doi:10.4103/jets.jets_186_20

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Patients manifesting ECG aberrations, notably nonspecific repolarization changes or ST depression, displayed a statistically significant association with the high-risk HEAR score group. This intricate relationship underscores the potential clinical implications of specific ECG alterations as markers for heightened cardiovascular risk in patients [21]. The observed correlation strengthens the diagnostic utility of the HEAR score, affirming its capacity to discern patients with distinct ECG patterns that may signify an increased susceptibility to adverse cardiac events.…”

Section: Discussionsupporting

confidence: 53%

Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina

Šljivo,

Lukić,

Altic

et al. 2024

Medicina

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Background and Objectives. In emergency departments, chest pain is a common concern, highlighting the critical importance of distinguishing between acute coronary syndrome and other potential causes. Our research aimed to introduce and implement the HEAR score, specifically, in remote emergency outposts in Bosnia and Herzegovina. Materials and Methods. This follow-up study conducted a retrospective analysis of a prospective cohort consisting of patients who were admitted to the remote emergency medicine outposts in Canton Sarajevo and Zenica from 1 November to 31 December 2023. Results. This study comprised 103 (12.9%) patients with low-risk HEAR scores and 338 (83.8%) with high-risk HEAR scores, primarily female (221, 56.9%), with a mean age of 63.5 ± 11.2). Patients with low-risk HEAR scores were significantly younger (50.5 ± 15.6 vs. 65.9 ± 12.1), had fewer smokers (p < 0.05), and exhibited a lower incidence of cardiovascular risk factors compared to those with high-risk HEAR scores. Low-risk HEAR score for prediction of AMI had a sensitivity of 97.1% (95% CI 89.9–99.6%); specificity of 27.3% (95% CI 22.8–32.1%); PPV of 19.82% (95% CI 18.67–21.03%), and NPV of 98.08% (95% CI 92.80–99.51%). Within 30 days of the admission to the emergency department outpost, out of all 441 patients, 100 (22.7%) were diagnosed with MACE, with AMI 69 (15.6%), 3 deaths (0.7%), 6 (1.4%) had a CABG, and 22 (4.9%) underwent PCI. A low-risk HEAR score had a sensitivity of 97.0% (95% CI 91.7–99.4%) and specificity of 27.3% (95% CI 22.8–32.1%); PPV of 25.5% (95% CI 25.59–28.37%); NPV of 97.14% (95% CI 91.68–99.06%) for 30-day MACE. Conclusions. In conclusion, the outcomes of this study align with existing research, underscoring the effectiveness of the HEAR score in risk stratification for patients with chest pain. In practical terms, the implementation of the HEAR score in clinical decision-making processes holds significant promise.

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Section: Discussionsupporting

confidence: 53%

Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina

Šljivo,

Lukić,

Altic

et al. 2024

Medicina

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“…T-wave inversion is generally seen hours or days after myocardial ischaemic pain subsides. During pain, T waves are usually upright with STelevation or ST depression [17]. Te T-wave change is not a sign of acute coronary occlusion but rather a sign of coronary artery reperfusion that is very likely to reocclude [18,19].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Wellens’ Syndrome in the Current PCI Era: A Single-Center Retrospective Study

Zhou

Gong

Chen

et al. 2023

Emergency Medicine International

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Objectives. The goal of this retrospective study was to reveal the prevalence, angiographic characteristics, clinical presentation, and long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) patients with Wellens’ syndrome. Background. Procedural results for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have improved in recent years. However, there is still a paucity of available clinical trial data for Wellens’ syndrome even though it is a well-known high-risk ACS. Methods. Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 at the Cardiovascular Center of Beijing Friendship Hospital, 476 NSTEMI patients with culprit left anterior descending (LAD) vessels were enrolled in this study. According to electrocardiographic criteria of Wellens’ syndrome, the patients were divided into a Wellens group (n = 138) and a non-Wellens group (n = 338). The primary endpoint was cardiac death; the secondary endpoints were main adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, cardiac death, heart failure, target lesion revascularization, recurrent myocardial infarction, and stroke. All of the medical and follow-up data were obtained from our institutional database. Results. The incidence of Wellens’ syndrome in all ACS patients was 5.7% (200 of 3528). Among the 200 patients with Wellens’ syndrome, 138 had NSTEMI, for a proportion of 69%. There was a significant decrease in the percentage of preexisting coronary heart disease (CHD), prior myocardial infarction, and previous PCI ( P < 0.05 ) in the Wellens group compared with the non-Wellens group. On coronary angiography, single-vessel lesions were more common in the Wellens group (11.6% vs. 5.3%, P = 0.016 ), and almost all (97.1%) of these patients received drug-eluting stents. Notably, the Wellens group had a higher proportion of early PCI than the non-Wellens group (71% vs. 61.2%, P = 0.044 ). At 24 months, there was no statistically significant difference in cardiac death ( P = 0.111 ) between the two groups, but the MACCEs were comparable (Wellens: 5.1% vs. non-Wellens: 13.3%, P = 0.009 ). Age ≥65 years was the largest independent risk factor for adverse prognosis. Conclusions. With early recognition and aggressive intervention, Wellens’ syndrome is no longer a risk factor for adverse prognosis in patients with NSTEMI in the current PCI era.

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Electrocardiogram to Determine Mitral and Aortic Valve Opening and Closure

Aufan

Jost

Miller

et al. 2023

Cardiovasc Eng Tech

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Early/Subtle Electrocardiography Features of Acute Coronary Syndrome and ST-Segment Elevation Myocardial Infarction

Cited by 3 publications

References 18 publications

Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina

Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina

Characteristics of Wellens’ Syndrome in the Current PCI Era: A Single-Center Retrospective Study

Electrocardiogram to Determine Mitral and Aortic Valve Opening and Closure

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