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Utility of the QT interval in predicting outcomes in patients presenting to the emergency department with chest pain

de Venecia, Toni A.a; Lu, Marvin Y.a; Nwakile, Chinualumogu C.b; Figueredo, Vincent M.b,c

doi: 10.1097/MCA.0000000000000249
Original Research

Objectives The aim of this study was to investigate whether prolongation of the heart rate-corrected QT interval (QTc) is an independent risk factor for predicting future acute coronary syndrome (ACS) occurrence or mortality in patients with at least one cardiac risk factor presenting with chest pain to the emergency department (ED).

Methods This is a single-center, retrospective study of patients presenting with chest pain to the ED of Einstein Medical Center, Philadelphia, between 2011 and 2012. Proportional hazards models were used to calculate hazard ratios (HRs) for occurrence of ACS or death within 1 year. Kaplan–Meier curves were used to determine the time to event for QTc low (<460 ms) versus QTc high (≥460 ms) groups.

Results A total of 595 patients met the inclusion criteria. Older age, hypertension, diabetes mellitus, and hyperlipidemia were more common in the QTc high group. Patients in the QTc high group were more likely to experience subsequent ACS or death (HR 8.12, 95% confidence interval 4.00–16.72), even after adjusting for traditional cardiac risk factors (HR 7.68, 95% confidence interval 3.57–16.61).

Conclusion QTc prolongation at ED presentation with chest pain and at least one cardiac risk factor predicts subsequent ACS and death.

aDepartment of Internal Medicine

bEinstein Institute for Heart and Vascular Health, Einstein Medical Center

cDepartment of Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence to Vincent M. Figueredo, MD, Einstein Institute for Heart and Vascular Health, 5501 Old York Road, 3rd Floor Levy Building, Philadelphia, PA 19141, USA Tel: +1 215 456 8991; fax: +1 215 456 3533; e-mail:

Received February 9, 2015

Received in revised form March 2, 2015

Accepted March 9, 2015

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