Abstract 9855: Presence of J-waves or Slurs in Chest Pain Patients Predicts Higher Mortality in those Diagnosed as Acute Myocardial Infarction

Abstract

BACKGROUND: Although early repolarization is known as a benign, J-waves or slurs on the R wave downslope have recently been associated with sudden cardiac death. We investigated the presence and prognostic significance of R wav downslope phenomena in patients presenting chest pain at the emergency department. METHODS: We performed a retrospective study of 747 chest pain patients. The presence of a J-wave or slurs in the 12-lead resting ECG recorded at the emergency department was defined as a QRS notching and or QRS slurring of more than 0.1mV relative to the PR-interval (QRSonset) as coded by a single observer using enhanced imaging (RA). Final diagnosis was adjudicated by two independent cardiologists having access to all acquired data including a 2 year follow-up period. Results: Of the participants (mean of age 61.9, 67.1% males), 16% had an acute myocardial infarction, 17% an unstable angina, 12% with cardiac symptoms other than CAD, 46% non-cardiac symptoms and 9% symptoms of unknown origin. There was a significant correlation between patients presenting J-waves/slurs and days in hospital (p=0.04), know hypertonia (p=0.003), known CAD (p=0.05), prior MI (p=0.04), and presence of T negativity (p=0.005) but no significant correlation with ST-segment elevation or depression. There was a significant lower survival rate (0.90 versus 0.94, p=0.03, HR=1.81) in presence of J-waves primarily due to the AMI subgroup (0.72 versus 0.94, p=0.002, HR=4.71). CONCLUSIONS: From this analysis we found an overall association between comorbidities and the presence of J-waves or slurs at the emergency department. A significant higher mortality rate in patients J-waves or slurs was only found in patients who evolved AMI.