{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:29:32Z","timestamp":1783211372067,"version":"3.54.6"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Identification of coronary ischemia may enable targeted diagnostic and therapeutic strategies for acute heart failure. We determined the risk of 30-day mortality associated with ischemic ECG abnormalities in patients with acute heart failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Among 8772 patients (53.4% women, median 78 years [Q1, Q3: 68,84]) presenting with acute heart failure to 86 hospital emergency departments in Ontario, Canada, Q-waves, T-wave inversion, or ST-depression were present in 51.8% of subjects. However, presence of ST-depression was the only finding associated with 30-day mortality with adjusted odds ratio 1.24 (95% confidence interval [CI], 1.02\u20131.50). Using continuous net reclassification improvement, addition of ST-depression to the Emergency Heart failure Mortality Risk Grade model reclassified 16.9% of patients overall, and 29.3% of those with a history of ischemic heart disease (both\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). By adding ST-depression to the model, the Emergency Heart failure Mortality Risk Grade was extended to predict 30-day death with high discrimination (\n              <jats:italic>c<\/jats:italic>\n              -statistic 0.801), with 0.57% mortality rate in the lowest risk decile. Adjusted odds ratios for 30-day mortality were 2.81 (95% CI, 1.48\u20135.31;\n              <jats:italic>P<\/jats:italic>\n              =0.002) in quintile 2, 7.41 (95% CI, 4.13\u201313.30;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) in quintile 3, and 14.47 (95% CI, 8.20\u201325.54;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) in quintile 4 compared with the lowest risk quintile. When the highest risk quintile was subdivided into 2 equally sized risk strata (deciles 9 and 10), the adjusted odds ratios for 30-day mortality were 27.20 (95% CI, 15.33\u201348.27;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) in decile 9 and 58.96 (95% CI, 33.54\u2013103.65;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) in highest risk decile 10.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Presence of ST-depression on the ECG reclassified risk of 30-day mortality in patients with acute heart failure, identifying both high- and low-risk subsets.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.114.001460","type":"journal-article","created":{"date-parts":[[2014,10,4]],"date-time":"2014-10-04T05:10:28Z","timestamp":1412399428000},"page":"986-993","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Ischemic Electrocardiographic Abnormalities and Prognosis in Decompensated Heart Failure"],"prefix":"10.1161","volume":"7","author":[{"given":"Douglas","family":"Greig","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Zhou","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack V.","family":"Tu","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Pang","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J.","family":"Ross","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Cat\u00f3lica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas S.","family":"Lee","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. 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