Acute pulmonary embolism (PE) may affect cardiac rate, rhythm, conduction pattern and repolarization manifesting a variety of nonspecific abnormalities on 12-lead electrocardiogram (ECG). No prior studies have examined the prognostic significance of these abnormalities. The purpose of this study was to determine the value of ECG abnormalities in predicting 30-day mortality in acute PE.
Between 1998 and 2000, 144 patients admitted with acute PE had an ECG and cardiac troponin I (cTnI) measurement within 24 hours of diagnosis. Medical records were abstracted for baseline characteristics, ECG findings and clinical outcomes. Patients were stratified according to 30-day mortality status. ECG findings and cTnI positivity (a documented strong predictor of 30-day mortality) were analyzed in order to determine the prognostic value of these indices.
Eighteen percent (26/144) of patients died within 30 days of PE diagnosis. Table 1Alive 30d (n=118)Death 30d (n=26)OR (95% CI)P valuePVCs4%23%6.8 (1.6–29.0)0.005*A. Fib6%23%4.8 (1.3–18.1)0.017*Low Volt QRS9%27%4.0 (1.2–13.3)0.021*Positive cTnI31%62%3.6 (1.4–9.7)0.006*S1S2S33%12%3.7 (0.6–21.6)0.213RBBB12%19%1.8 (0.5–6.1)0.493Anterior ST Depression9%15%1.8 (0.4–6.8)0.574Tachycardia42%54%1.6 (0.6–4.2)0.354Transition Zone V518%23%1.4 (0.4–4.3)0.728displays ECG findings and cTnI positivity in patients alive (mean age 68 ± 16 years, 46% male) and those dead (mean age 71 ± 15 years, 38% male) at 30 days. ECG findings of PVCs, atrial fibrillation and low QRS voltage are significantly associated with increased mortality.CONCLUSIONS: In the setting of acute PE, the presence of PVCs, atrial fibrillation and low QRS voltage on the 12-lead ECG at the time of presentation are significantly associated with increased 30-day mortality.
At the time of acute PE diagnosis, the 12-lead EKG offers important prognostic information. An electrocardiogram should therefore be performed on all patients presenting with acute PE.
J.A. Sallach, None.