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Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome

Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome
Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome

Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.

Acute Coronary Syndrome, Age Factors, Aged, Confidence Intervals, Diagnosis, Differential, Electrocardiography, Female, Follow-Up Studies, Hospital Mortality, Humans, Male, Odds Ratio, Patient Admission, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Survival Rate, United Kingdom, Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
0002-9149
307-313
Lown, Mark T
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Munyombwe, Theresa
a745e5f3-8197-47c8-a9ec-dcc341250534
Harrison, Wendy
9a623e76-5e89-4bbd-a9df-8adcbf9fae1e
West, Robert M
924e4166-bd25-4993-9a24-7f7fef6d3714
Hall, Christiana A
137b9577-59a7-4332-92e9-16577278c836
Morrell, Christine
a75fd6b7-e8fd-40a4-9ea1-ed5ea102054c
Jackson, Beryl M
99536c00-e50c-46bc-a175-3632a1610667
Sapsford, Robert J
f6d968fe-c0f7-4263-bf44-1a3ecd9cdc78
Kilcullen, Niamh
65c82ee0-7d4c-44a6-b9a4-144c9308906e
Pepper, Christopher B
8e590654-ab84-49de-b6a3-cd417622676a
Batin, Phil D
6ce74ad3-eb1d-4b5c-a62f-a750518c6659
Hall, Alistair S
c2861d32-b385-4fe9-9559-1562ca7b869c
Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805
Evaluation of Methods and Management of Acute Coronary Events (EMMACE) Investigators
Lown, Mark T
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Munyombwe, Theresa
a745e5f3-8197-47c8-a9ec-dcc341250534
Harrison, Wendy
9a623e76-5e89-4bbd-a9df-8adcbf9fae1e
West, Robert M
924e4166-bd25-4993-9a24-7f7fef6d3714
Hall, Christiana A
137b9577-59a7-4332-92e9-16577278c836
Morrell, Christine
a75fd6b7-e8fd-40a4-9ea1-ed5ea102054c
Jackson, Beryl M
99536c00-e50c-46bc-a175-3632a1610667
Sapsford, Robert J
f6d968fe-c0f7-4263-bf44-1a3ecd9cdc78
Kilcullen, Niamh
65c82ee0-7d4c-44a6-b9a4-144c9308906e
Pepper, Christopher B
8e590654-ab84-49de-b6a3-cd417622676a
Batin, Phil D
6ce74ad3-eb1d-4b5c-a62f-a750518c6659
Hall, Alistair S
c2861d32-b385-4fe9-9559-1562ca7b869c
Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805

Lown, Mark T, Munyombwe, Theresa, Harrison, Wendy, West, Robert M, Hall, Christiana A, Morrell, Christine, Jackson, Beryl M, Sapsford, Robert J, Kilcullen, Niamh, Pepper, Christopher B, Batin, Phil D, Hall, Alistair S and Gale, Chris P , Evaluation of Methods and Management of Acute Coronary Events (EMMACE) Investigators (2012) Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome. The American Journal of Cardiology, 109 (3), 307-313. (doi:10.1016/j.amjcard.2011.09.014).

Record type: Article

Abstract

Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.

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More information

Accepted/In Press date: 7 September 2011
e-pub ahead of print date: 8 November 2011
Published date: 1 February 2012
Keywords: Acute Coronary Syndrome, Age Factors, Aged, Confidence Intervals, Diagnosis, Differential, Electrocardiography, Female, Follow-Up Studies, Hospital Mortality, Humans, Male, Odds Ratio, Patient Admission, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Survival Rate, United Kingdom, Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 426287
URI: http://eprints.soton.ac.uk/id/eprint/426287
ISSN: 0002-9149
PURE UUID: e99a2b5b-b6b2-44a9-93b3-73e38794d988
ORCID for Mark T Lown: ORCID iD orcid.org/0000-0001-8309-568X

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Date deposited: 21 Nov 2018 17:30
Last modified: 11 Jul 2024 01:53

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Contributors

Author: Mark T Lown ORCID iD
Author: Theresa Munyombwe
Author: Wendy Harrison
Author: Robert M West
Author: Christiana A Hall
Author: Christine Morrell
Author: Beryl M Jackson
Author: Robert J Sapsford
Author: Niamh Kilcullen
Author: Christopher B Pepper
Author: Phil D Batin
Author: Alistair S Hall
Author: Chris P Gale
Corporate Author: Evaluation of Methods and Management of Acute Coronary Events (EMMACE) Investigators

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