Abstract
We studied the impact on triage and outcome of the presence of left ventricular hypertrophy
(LVH) and left/right bundle branch block (LBBB/RBBB) on the initial ED electrocardiogram
(ECG) for patients with symptoms suggestive of an acute coronary syndrome (ACS). Secondary
analysis of data from a prospective clinical trial of patients with chest pain or
other symptoms suggesting ACS in six U.S. hospitals comparing patient demographics,
clinical variables, and outcomes was used. Of 5,324 study patients, 3% had ECG-LVH,
3% had LBBB, 3% had RBBB, and 43% had ischemic ST segment or T wave abnormalities.
Compared with patients without ST segment or T wave abnormalities, patients with ECG-LVH
or BBB were older and were more likely to have a chief complaint of shortness of breath
or a history of cardiac or related diseases. Patients with ECG-LVH or BBB had more
diagnoses of congestive heart failure (CHF) and ACS compared with patients without
these ECG abnormalities and were just as likely to have ACS as their diagnosis compared
with patients with ischemic ST segment or T wave abnormalities. Having ECG-LVH or
BBB did not alter the true-positive rate for ACS but increased the false-positive
rate by almost 50%. Patients with ECG-LVH had approximately 3.5 times the 30-day mortality
rate as those without these ECG abnormalities. It appears that for patients with symptoms
suggestive of ACS, the presence of ECG-LVH or BBB did not alter the ability of ED
clinicians to identify patients with ACS but was associated with a 50% higher false-positive
admission rate compared with similar patients without these ECG abnormalities. With
a short-term mortality rate 3.5 times that for patients without ECG-LVH, selected
patients with ECG-LVH and symptoms suggesting ACS might benefit from hospitalization
for further evaluation.
Keywords
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Article Info
Publication History
Accepted:
April 18,
2003
Received:
April 18,
2003
Footnotes
☆Supported by Agency for Healthcare Research and Quality grant #RO1 HS07360.
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
