Introduction: Electrocardiogram (ECG) is one of the first investigations performed in emergency rooms in patients with chest pain, syncope or dyspnoea. Various studies have described the significance of ECG changes in patients with pulmonary thromboembolism (APE) with discordant outcome in terms of prognosis. Beca-use of these inconsistencies, the European guidelines for the diagnosis and treatment of patients with APE did not include ECG changes in the variables used to stratify the risk of poor outcome.
Methods: We prospectively evaluated 91 normotensi-ve patients with confirmed CT scan APE. The 12-lead electrocardiogram performed at the time of presentati-on in the emergency department was analyzed for this study.
Results: T he mean age of the analyzed population was 67±13.3 years. 61.5% of patients were women. In-hospital mortality of 15.4% was recorded. The most common ECG changes were the right bunddle branch block (RBBB) (44.9% patients), negative T waves in the precordial leads (44%) and the S1Q3T3 sign (37.4%). In-hospital mortality risk was 7.5 times higher in pa-tients with ST segment elevation in the inferior leads (OR=7.5, 95% CI 2.0- 27.9, p=0.003), 4.4 times higher in those with RBBB (OR 4.4, 95% CI 1.1-17.8, p=0.05) and 3.7 times higher in those with S1Q3T3 sign (OR 3.7, 95% CI 1.1-12.3, p=0.04). Patients with ST segment elevation in the precordial leads did not have a higher risk of early death during the hospitalisation period. The duration of the QRS complex and the corrected QT interval did not provide further significant informati-on on prognosis stratification. Atrial fibrillation at the time of presentation was not associated with a higher risk of adverse events. In the multivariate analysis of the PESI score, after adjustment for age and sex, only the presence of ST segment elevation in the inferior le-ads remained an independent predictor of in-hospital mortality (p=0.01).
Conclusions: Electrocardiogram, a wide-ranging, cost-effective, and safe investigation can bring relevant information in risk stratification of normotensive pati-ents with APE.