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Impact of QRS Duration on Non–ST-Segment Elevation Myocardial Infarction (from a National Registry)

Mamas

Impact of QRS Duration on Non–ST-Segment Elevation Myocardial Infarction (from a National Registry) Thumbnail


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Abstract

QRS duration (QRSd) is ill-defined and under-researched as a prognosticator in patients with non–ST-segment myocardial infarction (NSTEMI). We analyzed 240,866 adult (=18 years) hospitalizations with non–ST-segment elevation myocardial infarction using data from the United Kingdom Myocardial Infarction National Audit Project. Clinical characteristics and all-cause in-hospital mortality were analyzed according to QRSd, with 38,023 patients presenting with a QRSd >120 ms and 202,842 patients with a QRSd <120 ms. Patients with a QRSd >120 ms were more frequently older (median age of 79 years vs 71 years, p <0.001), and of white ethnicity (93% vs 91%, p <0.001). Patients with a QRSd <120 ms had higher frequency of use of aspirin (97% vs 95%, p <0.001), P2Y12 inhibitor (93% vs 89%, p <0.001), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (82% vs 81%, p <0.001) and ß blockers (83% vs 78%, p <0.001). Invasive management strategies were more likely to be used in patients with QRSd <120 ms including invasive coronary angiography (72% vs 54%, p <0.001), percutaneous coronary intervention (46% vs 33%, p <0.001) and coronary artery bypass graft surgery (8% vs 6%, p <0.001). In a propensity score matching analysis, there were no differences between the 2 groups in the adjusted rates of in-hospital all-cause mortality (odds ratio 0.94, 95% confidence interval 0.86 to 1.01) or major adverse cardiac events (odds ratio 0.94, 95% confidence interval 0.85 to 1.02) during the index admission. In conclusion, prolonged QRSd >120 ms in the context of non–ST-segment myocardial infarction is not associated with worse in-hospital mortality or the outcomes of major adverse cardiac events.

Acceptance Date Sep 11, 2022
Publication Date Nov 1, 2022
Publicly Available Date Mar 29, 2024
Journal The American Journal of Cardiology
Print ISSN 0002-9149
Publisher Elsevier
Pages 1 - 7
DOI https://doi.org/10.1016/j.amjcard.2022.07.039
Publisher URL https://www.sciencedirect.com/science/article/pii/S0002914922008566?via%3Dihub

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