ECG Core Laboratory
The CVC ECG Core Laboratory continues to evaluate patient data into clinically meaningful findings that have real world implications. Using quantitative data, the electrocardiogram (ECG) – a venerable but powerful biomarker – can improve the understanding of pathophysiologic processes involved in acute coronary syndromes, thereby enabling not only better prediction of outcomes, but also assessing treatment effectiveness. Using novel methods developed in the laboratory, this knowledge has informed further insights that in turn will impact future cardiovascular research. We have expanded the target populations of interest to evaluate the ECG characteristics of the VICTORIA trial heart failure population to enhance prognostic insights in this high-risk population, and test the efficacy of pharmaco-invasive therapy in the STREAM- 2 trial. We have also completed the ECG core lab analysis for the STRIVE trial as well as the NACMI registry.
The Vital Heart Program, led by Dr. Robert Welsh in collaboration with Dr. Kevin Bainey, has used the Core Laboratory to evaluate the prognostic significance of baseline Q waves and the effectiveness of reperfusion strategies in patients with ST-elevation myocardial infarction (STEMI). In close to 1000 early-presenting STEMI patients from the Vital Heart Response registry, almost a quarter of patients had baseline Q waves and had poorer reperfusion and worse outcomes at 30-days. A pharmacoinvasive strategy was associated with better ST-segment resolution than primary PCI regardless of Q wave status, with the greatest apparent benefit and lowest 1-year event rates observed in patients without baseline Q waves, suggesting Q wave status may help guide reperfusion choice when time-based pathways do not clearly favour one strategy.
Activities performed by the ECG Core Lab:
- Trial design facilitation
- Monitoring of protocol adherence
- ECG reading and analysis
- Pathophysiologic evaluation
- Prognosis and outcomes assessments
- Data management (including data entry, and quality control)
- Mechanistic studies to evaluate admissibility criteria, modeling of risk, evaluation of therapeutic interventions, and long term prognosis
- Collection and tracking of ECG tracings
- Analysis of ECG data and dissemination of results
Publications:
- Relationship between baseline electrocardiographic measurements and outcomes in patients with high-risk heart failure: Insights from the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial
- Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2
- Pharmaco-invasive strategy and dosing of tenecteplase in STEMI patients 60 to <75 years: An inter-trial comparison of the STREAM-1 and STREAM-2 trials
