Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction.

Grimm, Karin; Twerenbold, Raphael; Abaecherli, Roger; Boeddinghaus, Jasper; Nestelberger, Thomas; Koechlin, Luca; Troester, Valentina; Bourtzou, Anna; Keller, Dagmar I; Geigy, Nicolas; Kozhuharov, Nikola; Wussler, Desiree; Wildi, Karin; Hillinger, Petra; Rubini Giménez, Maria; Strebel, Ivo; Badertscher, Patrick; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Osswald, Luca; ... (2020). Diagnostic and prognostic value of ST-segment deviation scores in suspected acute myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 9(8), pp. 857-868. Sage 10.1177/2048872619853579

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BACKGROUND

Recent advances in digital electrocardiography technology allow evaluating ST-segment deviations in all 12 leads as quantitative variables and calculating summed ST-segment deviation scores. The diagnostic and prognostic utility of summed ST-segment deviation scores is largely unknown.

METHODS

We aimed to explore the diagnostic and prognostic utility of the conventional and the modified ST-segment deviation score (Better Analysis of ST-segment Elevations and Depressions in a 12- Lead-ECG-Score (BASEL-Score): sum of elevations in the augmented voltage right - lead (aVR) plus absolute, unsigned ST-segment depressions in the remaining leads) in patients presenting with suspected non-ST-segment elevation myocardial infarction. The diagnostic endpoint was non-ST-segment elevation myocardial infarction, adjudicated by two independent cardiologists. Prognostic endpoint was mortality during two-year follow up.

RESULTS

Among 1330 patients, non-ST-segment elevation myocardial infarction was present in 200 (15%) patients. Diagnostic accuracy for non-ST-segment elevation myocardial infarction as quantified by the area under the receiver-operating-characteristics curve was significantly higher for the BASEL-Score (0.73; 95% confidence interval 0.69-0.77) as compared to the conventional ST-segment deviation score (0.53; 95% confidence interval 0.49-0.57, p<0.001). The BASEL-Score provided additional independent diagnostic value to dichotomous electrocardiogram variables (ST-segment depression, T-inversion, both p<0.001) and to high-sensitivity cardiac troponin (p<0.001) as well as clinical judgment at 90 min (p<0.001). Similarly, only the BASEL-Score proved to be an independent predictor of two year mortality.

CONCLUSIONS

The modified ST-segment deviation score BASEL-Score focusing on ST-segment elevation in aVR and ST-segment depressions in the remaining leads provides incremental diagnostic and prognostic information.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2048-8734

Publisher:

Sage

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

30 Nov 2020 14:23

Last Modified:

12 Dec 2020 01:33

Publisher DOI:

10.1177/2048872619853579

PubMed ID:

31976746

Uncontrolled Keywords:

Acute coronary syndrome ST-segment deviation electrocardiogram

URI:

https://boris.unibe.ch/id/eprint/147588

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