P5016Usefulness of different electrocardiographic patterns as predictors of in-hospital mortality in acute pulmonary embolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Alarcon ◽  
J A Bilbao ◽  
R Melchiori ◽  
I M Cigalini ◽  
C E Scatularo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Sinus Tachycardia ◽  
P Value ◽  
P Waves ◽  
St Segment Elevation ◽  
St Segment ◽  
Acute Pe ◽  
T Waves

Abstract Background Many electrocardiographic (ECG) patterns may be present in acute pulmonary embolism (PE), but their prevalence and association with in hospital mortality (IHM) are less well established. Objective Assess the correlation between different ECG patterns and IHM in patients (Pts) with PE using a whole country dataset. Methods Prospective multicenter registry which included Pts with acute PE hospitalized in 75 academic centers from October 2016 to November 2017. We considered the following ECG patterns: sinus tachycardia, pulmonary P waves, Q waves in DII-aVF leads, negative T waves in V1-V4, ST segment elevation in aVR and V1, atrial fibrillation or atrial flutter (AF/AF), right bundle branch block (RBBB), ST segment depression, S1Q3T3 pattern or Qr in V1. Statistical analysis was carried out using de STATA version 13.1. A value of p<0.0.5 was considered statistically significant. Results We included 684 Pts; mean age 63.8±16.7 years (43% male). Global IHM was 12%. The most prevalent ECG patterns were sinus tachycardia (51.7%), S1Q3T3 (24.5%), negative T waves in V1- V4 (16%), RBBB (9.9%), AF/AF (8.6%). Four ECG patterns remained statistically significant predictors of IHM on multivariate analysis: AF/AF (OR: 3.81; CI 95% 1.82–7.95, p<0.01), pulmonary P waves (OR: 3.81; CI 95% 1.2–12, p<0.04), RBBB (OR: 2.71; CI 95% 1.39–5.30, p<0.01) and sinus tachycardia (OR: 2.05; CI 95% 1.18–3.54, p<0.04). ECG pattern and in-hospital mortality.Multivariate analysis Electrocardiographic pattern OR CI 95% p value AF/AF 3.81 1.82–7.95 <0.01 Pulmonary P waves 3.81 1.20–12.00 <0.04 RBBB 2.71 1.39–5.30 <0.01 Sinus tachycardia 2.05 1.18–3.54 <0.04 Q waves in DII-aVF 0.93 0.32–2.64 0.89 ST segment depression 1.07 0.39–2.96 0.80 Negative T waves in V1-V4 0.93 0.47–1.81 0.83 S1Q3T3 pattern 0.75 0.39–1.41 0.37 Qr in V1 2.07 0.63–6.73 0.22 ST segment elevation in aVR 2.38 0.79–7.15 0.12 Conclusions We corroborate the usefulness of the ECG as a prognostic tool in acute PE. Four simple ECG patterns (AF/AF, Pulmonary P waves, RBBB and sinus tachycardia) were associated with a higher IHM and therefore should be considered for PE risk stratification.

scholarly journals Correlation Between ST-Segment Elevation and Negative T Waves in the Precordial Leads in Acute Pulmonary Embolism: Insights into Serial Electrocardiogram Changes

2013 ◽  
Vol 19 (4) ◽  
pp. 398-405 ◽  
Author(s):  
Zhan Zhong-qun ◽  
Yang Bo ◽  
Kjell C. Nikus ◽  
Andrés Ricardo Pérez-Riera ◽  
Wang Chong-quan ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
St Segment Elevation ◽  
St Segment ◽  
T Waves

Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends

2011 ◽  
Vol 106 (07) ◽  
pp. 83-89 ◽  
Author(s):  
Davide Imberti ◽  
Walter Ageno ◽  
Francesco Dentali ◽  
Roberto Manfredini ◽  
Massimo Gallerani
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Techniques ◽  
Co Morbidity ◽  
Emilia Romagna Region ◽  
Morbidity Index ◽  
Hospital Administrative ◽  
Acute Pe

SummaryThe management of acute pulmonary embolism (PE) is often challenging and requires specific medical expertise, diagnostic techniques and therapeutic options that may not be available in all hospitals throughout the entire week. The aim of our study was to evaluate whether or not an association exists between weekday or weekend admission and mortality for patients hospitalised with acute PE. Using routinely collected hospital administrative data, we examined patients discharged with a diagnosis of PE from the hospitals of the Emilia- Romagna Region in Italy (January 1999-December 2009). The risk of inhospital death was calculated for admissions at the weekend and compared to weekday admissions. Of a total of 26,560 PEs, 6,788 (25.6%) had been admitted during weekends. PE admissions were most frequent on Mondays (15.8%) and less frequent on Saturdays and Sun- days/holidays (12.8%) (p<0.001). Weekend admissions were associated with significantly higher rates of in-hospital mortality than weekday admissions (28% vs. 24.8%) (p<0.001). The risk of weekend admission and in-hospital mortality was higher after adjusting for sender, hospital characteristics, and the Charlson co-morbidity index. In conclusion, hospitalisation for PE on weekends seems to be associated with a significantly higher mortality rate than on weekdays. Further research is needed to investigate the reasons for this observed difference in mortality in order to try and implement future strategies that ensure an adequate level of care throughout the entire week.

scholarly journals Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mukunthan Murthi ◽  
Hafeez Shaka ◽  
Zain El-amir ◽  
Sujitha Velagapudi ◽  
Abdul Jamil ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Nationwide Inpatient Sample ◽  
Acute Pulmonary Embolism ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Medical Problem ◽  
Mortality And Morbidity ◽  
Acute Pe

Abstract Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

ST-segment elevation in right precordial leads in acute pulmonary embolism

2011 ◽  
Vol 1 (2) ◽  
pp. 112-114
Author(s):  
Arunkumar Panneerselvam ◽  
PV Dattatreya ◽  
L Sridhar ◽  
B Prabhavathi ◽  
Manjunath C Nanjappa
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
St Segment Elevation ◽  
St Segment

scholarly journals The Impact of Age on the Delay in Diagnosis in Patients With Acute Pulmonary Embolism

2011 ◽  
Vol 17 (6) ◽  
pp. 605-610 ◽  
Author(s):  
T. M. Berghaus ◽  
C. Thilo ◽  
W. von Scheidt ◽  
M. Schwaiblmair
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
Older Patients ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Late Diagnosis ◽  
Hospital Death ◽  
Delay In Diagnosis ◽  
The Impact ◽  
Acute Pe

It has been speculated that the atypical clinical presentation of acute pulmonary embolism (PE) in older patients leads to a late diagnosis and therefore contributes to a worse prognosis. Therefore, we prospectively evaluated the delay in diagnosis and its relation to the in-hospital mortality in 202 patients with acute PE. Patients >65 years presented more often with hypoxia ( P = .017) and with a history of syncope ( P = .046). Delay in diagnosis was not statistically different in both age groups. Older age was significantly associated with an increased risk for in-hospital mortality (OR 4.36, 95% CI 0.93-20.37, P = .043), whereas the delay in diagnosis was not associated with an increase of in-hospital mortality. We therefore conclude that the clinical presentation of acute PE in older patients cannot be considered as a risk factor for late diagnosis and is not responsible for their higher in-hospital death rate.

scholarly journals Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

2015 ◽  
Vol 22 (5) ◽  
pp. 583-589 ◽  
Author(s):  
Zhong-Qun Zhan ◽  
Chong-Quan Wang ◽  
Zhi-Xiao Wang ◽  
Kjell C. Nikus ◽  
Adrian Baranchuk ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
St Segment ◽  
T Waves

scholarly journals Comparison of in Hospital Outcome of Patients with and without Distorted Terminal Portion of QRS Complex on Initial Electrocardiogram in ST Segment Elevation Myocardial Infarction

2016 ◽  
Vol 11 (1) ◽  
pp. 30-35
Author(s):  
Khandaker Aisha Siddika ◽  
Md Abu Siddique ◽  
Shamim Ahsan ◽  
Arif Hossain ◽  
Sohel Mahmud ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
P Value ◽  
Qrs Complex ◽  
Terminal Portion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of inhospital adverse outcome.Objectives: Our purpose of this study was to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent MI.Methods: We evaluated 60 patients of STEMI admitted within 12 hours and receiving thrombolytic therapy. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ?50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration.Results: Out of 60 patients of STEMI, 30(50.0%) patients had distortion of QRS. There were 7(11.6%) deaths, 16(26.7%) heart failure, 3(5.0%) cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (3.3% vs. 20.0%, p=0.04; 13.3% vs. 40.0%, p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0.0% vs. 10.0%, p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value < 0.05 ; OR=16.25, p value < 0.05 respectively).Conclusion: Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization procedure.University Heart Journal Vol. 11, No. 1, January 2015; 30-35

P6464Acute pulmonary embolism in Argentina. CONAREC XX registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I M Cigalini ◽  
C E Scatularo ◽  
J C C Jauregui ◽  
J I Ortego ◽  
D Cornejo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Hemodynamic Instability ◽  
Low Risk ◽  
P Value ◽  
Acute Pe

Abstract Background Pulmonary embolism (PE) represents the third cause of cardiovascular death and one of the leading causes of preventable in-hospital mortality. However, there is lack of information about this entity in our country. Purpose To describe baseline characteristics, in-hospital evolution and treatments among patients (P) admitted for acute PE in Argentina. Methods A prospective multicentric registry of P with acute PE was conducted in 75 academic centers between October 2016 and November 2017. Conventional analysis was used for descriptive and comparative statistics, with a p value <0.05 considered as significant. Cross audit was performed at 20% of participating centers. Results We included 684 consecutive P with an average age of 63,8 years (SD 16,8), with slight majority of female sex (57%). PE was the reason for admission in 484 (71%) of the cases; 68% of those others who developed PE as a complication during hospital stay were under adequate venous thromboembolism prophylaxis. The most frequent predisposing factors were obesity (34%), recent hospitalization (34%), transient rest (30%) and active cancer (22%). Multislice computed tomography was the diagnostic method of choice (81%). An echocardiogram was performed in 625 P (91%), showing right ventricular dilatation or dysfunction in 41% and 35% of the cases, respectively. After initial diagnosis, P were stratified as low risk (24%), intermediate-low risk (34%), intermediate-high risk (27%) and high risk (15%). Anticoagulation was indicated in 661 (97%), mainly with low-molecular-weight heparins (LMWH) (59%) as initial strategy. Reperfusion with either thrombolytics or mechanical therapies was performed in 91 (13%) cases. However, only 50 of the 102 P who presented with hemodynamic instability received any reperfusion therapy (49%). Overall in-hospital mortality was 12%, mainly related to PE (51%), with significant differences according to risk stratification (p<0,01) (Figure 1). 579 out of 601 survivors received anticoagulants at discharge: 60% vitamin K antagonists, 21% LMWH and 19% direct oral anticoagulants (49% Rivaroxaban, 34% Apixaban and 17% Dabigatran). Mortality according risk stratification Conclusions PE presents with high in-hospital mortality in our setting mainly due to the embolic event. This finding could be related to a low use of reperfusion therapies in P with hemodynamic instability, reflecting low adherence to guideline recommendations even in academic centers. This issue should be taken into consideration to improve PE prognosis in Argentina.

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