The prognostic significance of the electrical QRS axis on long-term mortality in acute coronary syndrome patients - The TACOS study

• Published in: Journal of electrocardiology Vol. 73; pp. 22 - 28
• Main Authors: Punkka, Olli, Kurvinen, Henri-Jussi, Koivula, Kimmo, Eskola, Markku J., Martiskainen, Mika, Huhtala, Heini, Virtanen, Vesa K., Mikkelsson, Jussi, Järvelä, Kati, Laurikka, Jari, Niemelä, Kari O., Karhunen, Pekka J., Pérez-Riera, Andrés Ricardo, Nikus, Kjell C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: Acute coronary syndrome; ECG; Long-term follow-up; Mortality; Outcome; QRS axis; ECG; Long-term follow-up; Acute coronary syndrome; Mortality; Outcome; QRS axis
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2022.04.007

There are several potential causes of QRS-axis deviation in the ECG, but there is limited data on the prognostic significance of QRS-axis deviation in ACS patients. We evaluated the long-term prognostic significance of acute phase frontal plane QRS-axis deviation and its shift during hospital stay in ACS patients. A total of 1026 patients who met the inclusion criteria were divided into three categories: normal (n = 823), left (n = 166) and right/extreme axis (n = 37). The median survival time was 9.0 years (95% CI 7.9—10.0) in the normal, 3.6 years (95% CI 2.4—4.7) in the left and 1.3 years (95% CI 0.2—2.4) in the right/extreme axis category. Both short and long-term all-cause mortality was lowest in the normal axis category and highest in the right/extreme axis category. Compared to normal axis, both admission phase QRS-axis deviation groups were independently associated with a higher risk of all-cause mortality. When including left ventricular hypertrophy in the ECG, only the right/extreme axis retained its statistical significance (aHR 1.76; 95% CI 1.16—2.66, p = 0.007). Axis shift to another axis category had no effect on mortality. In ACS patients, acute phase QRS-axis deviation was associated with higher risk of all-cause mortality. Among the axis deviation groups, right/extreme QRS-axis deviation was the strongest predictor of mortality in the multivariable analysis. Further studies are required to investigate to what extent this association is caused by pre-existing or by ACS-induced axis deviations. QRS-axis shift during hospital stay had no effect on all-cause mortality.