| 조현준, 윤재용, 김균희, 최원석, 박선희, 배명환, 이장훈, 양동헌, 박헌식, 조용근, 채성철, 전재은 |
Background: Previous studies reported that different electrocardiographic (ECG) variables could provide prognostic value for major adverse cardiac events (MACE) after acute myocardial infarction (AMI). However, most of these variables were not simple and not practical in daily practice. The aim of this study was to identify simple ECG parameters predicting MACE after AMI. Methods: Between January 2006 and January 2008, 494 patients (332 men; mean age = 69.1 ± 11.7 year-old) with AMI underwent standard 12-lead ECG from 3 to 7 days after AMI. Several PQRST time intervals and morphologies were analyzed by the Philips TraceMasterVue ECG management system. The MACEs were defined as death, non-fatal MI, and heart failure readmission. Mean follow-up duration was 396.8 ± 140.7 days. Results: Of these patients, 473 (95.7%) patients provided complete follow-up data. During the follow-up, 62 (13.1%) MACEs occurred including 30 (6.3%) deaths, 22 (4.7%) heart failure readmission, and 10 (2.1%) non-fatal MIs. In univariate analysis, time-voltage QRS area, Q duration, ST duration, and mean QTc interval had a significant association with MACEs among ECG variables. In the Cox proportional hazard model, time-voltage QRS area (hazard ratio [HR] 1.032, 95% confidence interval [CI] 1.003 to 1.061, p = 0.027) in addition to log-transformed serum N-terminal pro-B type natriuretic peptide levels (HR 1.369, 95% CI 1.049 to 1.787, p = 0.021) were independent predictors of MACEs among ECG variables after adjustment for age, sex, Killip class >2, past history of coronary heart disease, diabetes mellitus, estimated glomerular filtration rate, serum levels of hemoglobin, total cholesterol, and log-transformed high-sensitivity C-reactive protein. In receiver-operator characteristic curve, the area under curve of time-voltage QRS area for predicting MACEs was 0.705 ± 0.036 (sensitivity 82.3%, specificity 51.8%; p<0.001), and optimum cut-off value was 10.85 uVs. Kaplan-Meier survival curve showed patients with time-voltage QRS area ≥10.85 uVs (20.5% versus 4.9%; log-rank test p < 0.001) had significantly higher MACEs. Conclusions: This study suggest that simple time-voltage QRS area measurements derived from a standard digitally acquired 12-lead ECG using commercially available equipment could provide prognostic value in patients with AMI.
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