�tude � grande �chelle qui confirme ce que l'on savait. Paru dans JAMA
cete semaine.
BM
Prognostic Value of a
Normal or Nonspecific Initial
Electrocardiogram in
Acute Myocardial Infarction
Robert D. Welch, MD;
Robert J. Zalenski, MD; Paul D. Frederick, MPH, MBA; Judith
A. Malmgren, PhD; Scott
Compton, PhD; Mary Grzybowski, PhD, MPH; Sophia
Thomas, MD; Terry
Kowalenko, MD; Nathan R. Every, MD, MPH; for the National
Registry of Myocardial
Infarction 2 and 3 Investigators
Context Although
previous studies have suggested that normal and nonspecific initial
electrocardiograms
(ECGs) are associated with a favorable prognosis for patients with
acute myocardial
infarction (AMI), their independent predictive value for mortality has
not been examined.
Objective To compare
in-hospital mortality among patients with AMI who have normal
or nonspecific initial
ECGs with that of patients who have diagnostic ECGs.
Design, Setting, and
Patients Multihospital observational study in which 391 208
patients with AMI met
the study criteria between June 1994 and June 2000 and had
ECGs that were normal (n
= 30 759), nonspecific (n = 137 574), or diagnostic (n =
222 875; defined as
ST-segment elevation or depression and/or left bundle-branch
block). A logistic
regression model was constructed using a propensity score for ECG
findings and data on
demographics, medical history, diagnostic procedures, and
therapy to determine the
independent prognostic value of a normal or nonspecific initial
ECG.
Main Outcome Measures
In-hospital mortality; composite outcome of in-hospital
death and
life-threatening adverse events.
Results In-hospital
mortality rates were 5.7%, 8.7%, and 11.5% while the rates of the
composite of mortality
and life-threatening adverse events were 19.2%, 27.5%, and
34.9% for the normal,
nonspecific, and diagnostic ECG groups, respectively. After
adjusting for other
predictor variables, the odds of mortality for the normal ECG group
was 0.59 (95% confidence
interval [CI], 0.56-0.63; P<.001) and for the nonspecific
group was 0.70 (95% CI,
0.68-0.72; P<.001), compared with the diagnostic ECG
group.
Conclusion In this
large cohort of patients with AMI, patients presenting with normal or
nonspecific ECGs did
have lower in-hospital mortality rates than those of patients with
diagnostic ECGs, yet the
absolute rates were still unexpectedly high.
JAMA. 2001;286:1977-1984
