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Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease
Journal article   Peer reviewed

Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease

Rajesh Pradhan, Ashok Chaudhary and Anthony A. Donato
The American journal of emergency medicine, v 30(7), pp 1042-1047
01 Sep 2012
DOI: https://doi.org/10.1016/j.ajem.2011.06.027
PMID: 21855255
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Rapid atrial fibrillation (AF) is commonly associated with ST-segment depressions. ST-segment depression during a chest pain episode or exercise stress testing in sinus rhythm is predictive of obstructive coronary artery disease (CAD), but it is unclear if the presence or magnitude of ST-segment depression during rapid AF has similar predictive accuracy. One hundred twenty-seven patients with rapid AF (heart rate ≥120 beats per minute) who had cardiac catheterization performed during the same hospital admission were retrospectively reviewed. Variables to compute thrombolysis in myocardial infarction (TIMI) risk score, demographic profiles, ST-segment deviation, cardiac catheterization results, and cardiac interventions were collected. Thirty-five patients had ST-segment depression of 1 mm or more, and 92 had no or less than 1 mm ST depression. Thirty-one patients were found to have obstructive CAD. In the group with ST-segment depression, 11 (31%) patients had obstructive CAD and 24 (69%) did not. In the group with less than 1 mm ST-segment depression, 20 (22%) had obstructive CAD and 72 (78%) did not (P = .25). Sensitivity, specificity, and positive and negative predictive values for presence of obstructive CAD were 35%, 75%, 31%, and 78%, respectively. The presence of ST-segment depression of 1 mm or more was not associated with presence of obstructive CAD before or after adjustment of TIMI variables. The relationship between increasing grades of ST-segment depression and obstructive CAD showed a trend toward significance (P = .09), which did not persist after adjusting for TIMI risk variables (P = .36). ST-segment depression during rapid AF is not predictive for the presence of obstructive CAD.

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Emergency Medicine
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