Prognostic Value of a Normal or Nonspecific Initial Electrocardiogram in Acute Myocardial Infarction

Abstract

In this large cohort of patients with AMI, patients presenting with normal or nonspecific ECGs did have lower in-hospital mortality rates than those of patients with diagnostic ECGs, yet the absolute rates were still unexpectedly high.

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

“…The size of this subgroup is considerable and amounts to 7.3% of all the patients admitted for AMI participating in the study. This rate is comparable with the percentage range of AMI patients with a normal ECG on admission found in earlier studies with similar inclusion criteria, in which the rates vary from 3% to 17% [4,[12][13][14][15]. The broad variation in the percentages of normal AMI can be explained by the different criteria defining an ECG pattern as normal/non-specific.…”

“…Despite similar presentation characteristics, the treatment received by patients with a normal/non-specific ECG was less aggressive. This was also the case in a similar study [4] which noted that these patients presented with less typical AMI symptoms and were given their first ECG after a longer delay. In this study procedures were performed after a longer interval after symptom onset.…”

“…This makes comparison between the various studies difficult [16]. In a study by Welch et al [4], as many as 35.1% of the AMI patients studied belonged to the non-specific group, a rate much higher than in this study simply due to the ECG classification criteria and not to a completely different patient collective.…”

Frequency of Acute Coronary Syndrome in Patients with Normal Electrocardiogram Performed during Presence or Absence of Chest Pain

“…No patient whose ECG remained negative suffered an in‐hospital complication. Similar to the study by Welch et al, 17 Zalenski and colleagues “affirm the notion there is no ‘safe’ AMI.” 18 …”

Diabetes and Stress Hyperglycemia Associated With Myocardial Infarctions at an Urban Municipal Hospital

“…In perhaps the most comprehensive database, the National Registry of Myocardial Infarctions, the prevalence of diabetes was 26.5% of 391,208 patients. 30 Finally, the prevalence is higher in our study than a much older population of patients in the Medicare database. 31 These comparisons support the finding that diabetes is more common at presentation with myocardial infarction in our population than in other cohorts.…”