Abstract

Background: the prognostic performances of different ECG interpretation methods have not been compared.

Methods: the 100 day mortality of 513 patients predicted by Marquette proprietary ECG software, Tan et al’s scoring system and the myocardial micro-alternation index (MMI) were compared.

Results: 33 patients (6.4%) died within 100 days of hospital admission. The c statistics for Mar

quette and Tan ECG interpretation and MMI were not statistically different (i.e. 0.64, 0.68 and 0.73, respectively). Only MMI was independent from age as a predictor of mortality. The c statistic for MMI plus age of 0.81 was significantly higher than that of Marquette ECG interpretation (p 0.015).

Conclusion: predictions of 100 day mortality by of all three ECG interpretation methods are equivalent.

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Abstract

References

1. Christakis NA. Death Foretold: Prophecy and Prognosis in Medical Care, 1st ed. Chicago, IL: The University of Chicago Press; 1999.
2. Pompei P, Charlson ME, Douglas Jr RG. Clinical assessments as predictors of one year survival after hospitalization: implications for prognostic stratification. J Clin Epidemiol 1988;41:275–84.
3. Kellett J., Deane B. The Simple Clinical Score predicts mortality for days after admission to an acute medical unit. Q.J.Med. 2006;99:771-781.
4. De Bacquer D, De Backer G, Kornitzer M, Blackburn H. Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women Heart 1998;80:570–577
5. Greenland P, Xie X, Liu K, Colangelo L, Liao Y, Daviglus ML, Agulnek AN, Stamler J. Impact of Minor Electrocardiographic ST Segment and/or T-Wave Abnormalities on Cardiovascular Mortality During Long-Term Follow-Up. Am J Cardiol 2003;91:1068-1074.
6. Auer R, Bauer DC, Marques-Vidal P, Butler J, Min LJ, Cornuz J, Satterfield S, Newman AB, Vittinghoff E, Rodondi N and Health ABC study. Association of Major and Minor ECG Abnormalities With Coronary Heart Disease Events. JAMA 2012;307:1497- 1505.
7. Groot A, Bots ML, Rutten FH, den Ruijter HM, Numans ME, Vaartjes I. Measurement of ECG abnormalities and cardiovascular risk classification: a cohort study of primary care patients in the Netherlands Br J Gen Pract 2015;65:e1-e8
8. Kellett J., Deane B., Gleeson M. Derivation and validation of a score based on Hypotension, Oxygen saturation, low Temperature, ECG changes and Loss of independence (HOTEL) that predicts early mortality between 15 minutes and 24 hours after admission to an acute medical unit. Resuscitation 2008;78:52-8
9. Wheeler I., Price C., Sitch A., Banda P., Kellett J., Nyirenda M., Rylance J. Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi: a prospective cohort study. PlosOne 8(3): e59830. doi:10.1371/journal.pone.0059830
10. Tan SY, Sungar GW, Myers J, Sandri M, Froelicher V. A Simplified Clinical Electrocardiogram Score for the Prediction of Cardiovascular Mortality. Clin Cardiol 2009;32:82-86.
11. Cruz-Gonzalez I, Dejoseph-Gauthier D, Chia S, Raffel OC, Jang I-K. Non-invasive assessment of myocardial ischaemia by using low amplitude oscillations of the conventional ECG signals (ECG dispersion mapping) during percutaneous intervention. Acta Cardiol 2009;64:11–5.
12. Ryabykina GV, Sula AS, Shchedrina EV. Experience with device Cardiovisor in cardiological care. Turk J Invasive Cardiol 2006;10:138–45.
13. Kellett J, Rasool S, The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores — A pilot study. Eur J Intern Med 2011;22:394-398
14. Kellett J., Rasool S., McLoughlin B. Prediction of mortality 1 year after hospital admission. Q J Med 2012;105:847-53.
15. Royal College of Physicians. National Early Warning Score (NEWS): standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP; 2012. .
16. Yang J-S, Nam H-J, SeoM, Han SK, Choi Y, et al. OASIS: Online Application for the Survival Analysis of Lifespan Assays Performed in Aging Research. PLoS ONE 2011;6: e23525. http://dx.doi. org/10.1371/journal.pone.0023525.
17. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839–43. 18. Lynn J, Goldstein NE. Advance care planning for fatal chronic illness: avoiding commonplace errors and unwarranted suffering. Ann Intern Med. 2003; 138:812–8.