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ST-segment elevation in baseline electrocardiogram predicts mortality in cardiogenic shock

Session Poster Session 2

Speaker Tuija Sabell

Event : Heart Failure 2017

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure - Other
  • Session type : Poster Session

Authors : T Javanainen (Helsinki,FI), HEV Tolppanen (Helsinki,FI), VP Harjola (Helsinki,FI), J Lassus (Helsinki,FI), T Tarvasmaki (Helsinki,FI), MS Nieminen (Helsinki,FI), J Spinar (Brno,CZ), A Sionis (Barcelona,ES), M Banaszewski (Warsaw,PL), R Jurkko (Helsinki,FI)

Authors:
T Javanainen1 , HEV Tolppanen1 , VP Harjola2 , J Lassus3 , T Tarvasmaki1 , MS Nieminen1 , J Spinar4 , A Sionis5 , M Banaszewski6 , R Jurkko1 , 1Helsinki University Central Hospital - Helsinki - Finland , 2Helsinki University Central Hospital, Emergency medicine - Helsinki - Finland , 3Helsinki University Central Hospital, Heart and Lung Center - Helsinki - Finland , 4University Hospital Brno, Department of Internal Medicine and Cardiology - Brno - Czech Republic , 5Hospital de la Santa Creu i Sant Pau, Intensive Cardiac Care Unit, Cardiology Department - Barcelona - Spain , 6Institute of Cardiology - Warsaw - Poland ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 216

Background: The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but 20 % of CS is caused by other disorders. ST-segment deviations in electrocardiogram (ECG) have previously been investigated in patients with CS caused by ACS but not in those with other CS aetiologies.

Purpose: The aim was to explore the prevalence of different ST-segment patterns and their association with the aetiology and 30-day mortality in CS.

Methods: We analysed the baseline ECG of 196 patients who were included in a multinational prospective cohort study of CS. The patients were divided into three groups according to their ECG: 1) ST-segment elevation (STE): ST-segment elevation at the J point in two contiguous leads with following cut-points: = 0.1 mV in all leads other than leads V2 – V3 where the following cut points apply: = 0.2 mV in men = 40 years; = 0,25mV in men < 40 years, or = 0.15 mV in women. 2) ST-segment depression (STDEP): horizontal or down-sloping ST-depression = 0.05 mV in two contiguous leads. 3) No ST-segment deviation or ST-segment impossible to analyse (NSTED). The multivariable model was adjusted for age, gender, left ventricular ejection fraction and comorbidities.

Results: Mean age was 66 years, 74 % were men, and 81 % had ACS as CS aetiology. The prevalence of any ST-segment deviation was 80 % (n=157). Half of the patients had STE (n= 105, 54 %) and one fourth had STDEP (n = 52, 27 %). Remaining 20 % (n = 39) comprised NSTED group. The prevalence of ACS aetiology was higher in patients with STE (93 %) in comparison with STDEP (71 %, p < 0.01) and NSTED (59 %, p < 0.01). Overall, 30-day mortality was 36%; in STE group 42 %, STDEP 31 % and NSTED 28 % (p = 0.18). In multivariable analysis, STE was an independent predictor of mortality (HR 2.09, 95 % CI 1.25 - 3.51) along with increasing age, previous ischaemic heart disease and left ventricular ejection fraction (Figure).

Conclusions: Most CS patients have ST-segment deviations in baseline ECG. STE is strongly associated with ACS aetiology. Interestingly, CS aetiology was other than ACS in one third of patients with STDEP. Furthermore, CS was caused by ACS in over half of the NSTED patients. Importantly, STE is an independent predictor of 30-day mortality.

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