Please use this identifier to cite or link to this item: https://doi.org/10.1186/s13054-016-1367-5
Title: A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain
Authors: Heldeweg, M.L.A
Liu, N 
Koh, Z.X
Fook-Chong, S
Lye, W.K 
Harms, M
Ong, M.E.H 
Keywords: acute heart infarction
adult
age
Article
cardiovascular disease assessment
cardiovascular risk
cohort analysis
controlled study
death
demography
electrocardiogram
electronic medical record
emergency ward
female
gender
heart disease
heart rate
human
intermethod comparison
major clinical study
male
observational study
predictive value
priority journal
prognostic assessment
Q wave
QT prolongation
revascularization
risk assessment
sensitivity analysis
sinus rhythm
ST segment depression
ST segment elevation
thorax pain
thrombolysis in myocardial infarct score
validation process
vital sign
aged
Cardiovascular Diseases
decision support system
electrocardiography
heart rate
hospital emergency service
middle aged
mortality
organization and management
outcome assessment
physiology
procedures
prognosis
prospective study
risk assessment
Singapore
standards
statistical model
Aged
Cardiovascular Diseases
Cohort Studies
Decision Support Techniques
Electrocardiography
Emergency Service, Hospital
Female
Heart Rate
Humans
Logistic Models
Male
Middle Aged
Patient Outcome Assessment
Prognosis
Prospective Studies
Risk Assessment
Singapore
Issue Date: 2016
Publisher: BioMed Central Ltd.
Citation: Heldeweg, M.L.A, Liu, N, Koh, Z.X, Fook-Chong, S, Lye, W.K, Harms, M, Ong, M.E.H (2016). A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain. Critical Care 20 (1) : 179. ScholarBank@NUS Repository. https://doi.org/10.1186/s13054-016-1367-5
Rights: Attribution 4.0 International
Abstract: Background: Risk stratification models can be employed at the emergency department (ED) to evaluate patient prognosis and guide choice of treatment. We derived and validated a new cardiovascular risk stratification model comprising vital signs, heart rate variability (HRV) parameters, and demographic and electrocardiogram (ECG) variables. Methods: We conducted a single-center, observational cohort study of patients presenting to the ED with chest pain. All patients above 21 years of age and in sinus rhythm were eligible. ECGs were collected and evaluated for 12-lead ECG abnormalities. Routine monitoring ECG data were processed to obtain HRV parameters. Vital signs and demographic data were obtained from electronic medical records. Thirty-day major adverse cardiac events (MACE) were the primary endpoint, including death, acute myocardial infarction, and revascularization. Candidate variables were identified using univariate analysis; the model for the final risk score was derived by multivariable logistic regression. We compared the performance of the new model with that of the thrombolysis in myocardial infarct (TIMI) score using receiver operating characteristic (ROC) analysis. Results: In total, 763 patients were included in this study; 254 (33 %) met the primary endpoint, the mean age was 60 (σ = 13) years, and the majority was male (65 %). Nineteen candidate predictors were entered into the multivariable model for backward variable elimination. The final model contained 10 clinical variables, including age, gender, heart rate, three HRV parameters (average R-to-R interval (RR), triangular interpolation of normal-to-normal (NN) intervals, and high-frequency power), and four 12-lead ECG variables (ST elevation, ST depression, Q wave, and QT prolongation). Our proposed model outperformed the TIMI score for prediction of MACE (area under the ROC curve 0.780 versus 0.653). At the cutoff score of 9 (range 0-37), our model had sensitivity of 0.709 (95 % CI 0.653, 0.765), specificity of 0.674 (95 % CI 0.633, 0.715), positive predictive value of 0.520 (95 % CI 0.468, 0.573), and negative predictive value of 0.823 (95 % CI 0.786, 0.859). Conclusions: A non-invasive and objective ECG- and HRV-based risk stratification tool performed well against the TIMI score, but future research warrants use of an external validation cohort. © 2016 The Author(s).
Source Title: Critical Care
URI: https://scholarbank.nus.edu.sg/handle/10635/179566
ISSN: 1364-8535
DOI: 10.1186/s13054-016-1367-5
Rights: Attribution 4.0 International
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