QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department - 15/07/18

Doi : 10.1016/j.ajem.2018.07.022

Jennifer L. White, MD ^a,^{^⁎} , Anna Marie Chang, MD, MSCE ^a, Judd E. Hollander, MD ^a, Erica Su, BS ^b, Robert E. Weiss, PhD ^b, Annick N. Yagapen, MPH, CCRP ^c, Susan E. Malveau, MSBE ^c, David H. Adler, MD, MPH ^d, Aveh Bastani, MD ^e, Christopher W. Baugh, MD, MBA ^f, Jeffrey M. Caterino, MD, MPH ^g, Carol L. Clark, MD, MBA ^h, Deborah B. Diercks, MD, MPH ⁱ, Bret A. Nicks, MD, MHA ^j,^k, Daniel K. Nishijima, MD, MAS ^c, Manish N. Shah, MD, MPH ^l, Kirk A. Stiffler, MD ^m, Alan B. Storrow, MD ⁿ, Scott T. Wilber, MD ^m, Benjamin C. Sun, MD, MPP ^c
^a Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
^b Department of Biostatistics, University of California, Los Angeles, CA, United States of America
^c Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
^d Department of Emergency Medicine, University of Rochester, NY, United States of America
^e Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
^f Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
^g Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
^h Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
ⁱ Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
^j Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America
^k Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
^l Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
^m Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
ⁿ Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America

^⁎Corresponding author.

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Abstract

Background

Syncope is a common chief complaint in the ED, and the electrocardiogram (ECG) is a routine diagnostic tool in the evaluation of syncope. We assessed whether increasingly prolonged QTc intervals are associated with composite 30-day serious outcomes in older adults presenting to the ED with syncope.

Methods

This is a secondary analysis of a prospective, observational study at 11 EDs in adults 60 years or older who presented with syncope or near syncope. We excluded patients presenting without an ECG, measurement of QTc, non-sinus rhythm, bundle branch block or those without 30-day follow-up. We categorized QTc cutoffs into values of <451; 451–470; 471–500, and >500 ms. We determined the rate of composite 30-day serious outcomes including ED serious outcomes and 30-day arrhythmias not identified in ED.

Results

The study cohort included 2609 patients. There were 1678 patients (64.3%) that had QTc intervals <451 ms; 544 (20.8%) were 451–470 ms; 302 (11.6%) were 471–500 ms, and 85 (3.3%) had intervals >500 ms. Composite 30-day serious outcomes was associated with increasingly prolonged QTc intervals (13.0%, 15.3%, 18.2%, 22.4%, p = 0.01), but this association did not persist in multivariate analysis.

Conclusions

In a cohort of older patients presenting with syncope, increased QTc interval was a marker of but was not independently predictive of composite 30-day serious outcomes.

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