PMID- 34365136
OWN - NLM
STAT- MEDLINE
DCOM- 20211022
LR  - 20211022
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 68
DP  - 2021 Sep-Oct
TI  - The prognostic significance of grade of ischemia in the ECG in patients with 
      ST-elevation myocardial infarction: A substudy of the randomized trial of primary 
      PCI with or without routine manual thrombectomy (TOTAL trial).
PG  - 65-71
LID - S0022-0736(21)00158-8 [pii]
LID - 10.1016/j.jelectrocard.2021.07.015 [doi]
AB  - BACKGROUND: The importance of the grade of ischemia (GI) ECG classification in 
      the risk assessment of patients with STEMI has been shown previously. Grade 3 
      ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion 
      of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is 
      defined as ST-elevation without QRS distortion. Our aim was to evaluate the 
      prognostic impact of the GI classification on the outcome in patients with STEMI. 
      METHODS: 7,211 patients from the TOTAL trial were included in our study. The 
      primary outcome was a composite of cardiovascular death, recurrent myocardial 
      infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV 
      heart failure within one year. RESULTS: The primary outcome occurred in 153 of 
      1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the 
      G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of 
      cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; 
      p=0.013) was also higher in patients with G3I. CONCLUSIONS: G3I in the presenting 
      ECG was associated with an increased rate of the composite of cardiovascular 
      death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one 
      year compared to patients with G2I. Patients with G3I also had a higher 
      cardiovascular death compared to patients with G2I.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Leivo, Joonas
AU  - Leivo J
AD  - Internal medicine, Kanta-Hame Central Hospital, Hameenlinna, Ahvenistontie 20, 
      13530 Hameenlinna, Finland; Faculty of Medicine and Health Technology, Tampere 
      University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpon katu 
      34, 33520 Tampere, Finland. Electronic address: joonas.leivo@fimnet.fi.
FAU - Anttonen, Eero
AU  - Anttonen E
AD  - Paijat-sote, Primary health care, Lahti, Keskussairaalankatu 7, 15850 Lahti, 
      Finland.
FAU - Jolly, Sanjit S
AU  - Jolly SS
AD  - Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, 
      ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 
      Main Street West, Hamilton, Ontario L8S4L8, Canada; Hamilton Health Sciences, 
      Hamilton, P.O. Box 2000, Hamilton, ON L8N 3Z5, Canada.
FAU - Dzavik, Vladimir
AU  - Dzavik V
AD  - Peter Munk Cardiac Centre, University Health Network, Toronto, R. Fraser Elliott 
      Building, 1st Floor 190 Elizabeth St., Toronto, ON M5G 2C4, Canada.
FAU - Koivumaki, Jyri
AU  - Koivumaki J
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Tays 
      Sydankeskus Oy, PL 2000, 33521 Tampere, Finland.
FAU - Tahvanainen, Minna
AU  - Tahvanainen M
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Tays 
      Sydankeskus Oy, PL 2000, 33521 Tampere, Finland.
FAU - Koivula, Kimmo
AU  - Koivula K
AD  - Internal medicine, South Karelia Central Hospital, Valto Kakelan katu 1, 
      Lappeenranta 53130, Finland.
FAU - Nikus, Kjell
AU  - Nikus K
AD  - Faculty of Medicine and Health Technology, Tampere University and Finnish 
      Cardiovascular Research Center, Tampere, Arvo Ylpon katu 34, 33520 Tampere, 
      Finland; Heart Center, Department of Cardiology, Tampere University Hospital, 
      Tays Sydankeskus Oy, PL 2000, 33521 Tampere, Finland.
FAU - Wang, Jia
AU  - Wang J
AD  - Population Health Research Institute, Hamilton, 237 Barton Street East, Hamilton, 
      ON L8L 2X2, Canada; Department of Medicine, McMaster University, Hamilton, 1280 
      Main Street West, Hamilton, Ontario L8S4L8, Canada; David Braley Cardiac, 
      Vascular and Stroke Research Institute, Hamilton, Faculty of Health Sciences, 
      1280 Main St. W., Hamilton, Ontario L8S4K1, Canada.
FAU - Cairns, John A
AU  - Cairns JA
AD  - The University of British Columbia, 2329 West Mall, Vancouver, British Columbia 
      V6T1Z4, Canada.
FAU - Niemela, Kari
AU  - Niemela K
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Tays 
      Sydankeskus Oy, PL 2000, 33521 Tampere, Finland.
FAU - Eskola, Markku
AU  - Eskola M
AD  - Faculty of Medicine and Health Technology, Tampere University and Finnish 
      Cardiovascular Research Center, Tampere, Arvo Ylpon katu 34, 33520 Tampere, 
      Finland; Heart Center, Department of Cardiology, Tampere University Hospital, 
      Tays Sydankeskus Oy, PL 2000, 33521 Tampere, Finland.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210727
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Electrocardiography
MH  - Humans
MH  - *Myocardial Infarction/diagnosis
MH  - *Percutaneous Coronary Intervention
MH  - Prognosis
MH  - *ST Elevation Myocardial Infarction/diagnosis/surgery
MH  - Thrombectomy
OTO - NOTNLM
OT  - ECG
OT  - Grade of Ischemia
OT  - Q wave
OT  - STEMI
EDAT- 2021/08/09 06:00
MHDA- 2023/02/25 06:00
CRDT- 2021/08/08 20:43
PHST- 2021/05/09 00:00 [received]
PHST- 2021/07/12 00:00 [revised]
PHST- 2021/07/20 00:00 [accepted]
PHST- 2021/08/09 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2021/08/08 20:43 [entrez]
AID - S0022-0736(21)00158-8 [pii]
AID - 10.1016/j.jelectrocard.2021.07.015 [doi]
PST - ppublish
SO  - J Electrocardiol. 2021 Sep-Oct;68:65-71. doi: 10.1016/j.jelectrocard.2021.07.015. 
      Epub 2021 Jul 27.