The prognostic significance of the electrical QRS axis on long-term mortality in acute coronary syndrome patients: The TACOS study

Olli Punkka, Henri Jussi Kurvinen, Kimmo Koivula, Markku J. Eskola, Mika Martiskainen, Heini Huhtala, Vesa K. Virtanen, Jussi Mikkelsson, Kati Järvelä, Jari Laurikka, Kari O. Niemelä, Pekka J. Karhunen, Andrés Ricardo Pérez-Riera, Kjell C. Nikus

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Introduction: There are several potential causes of QRS-axis deviation in the ECG, but there is limited data on the prognostic significance of QRS-axis deviation in ACS patients. Subjects and methods: We evaluated the long-term prognostic significance of acute phase frontal plane QRS-axis deviation and its shift during hospital stay in ACS patients. A total of 1026 patients who met the inclusion criteria were divided into three categories: normal (n = 823), left (n = 166) and right/extreme axis (n = 37). Results: The median survival time was 9.0 years (95% CI 7.9—10.0) in the normal, 3.6 years (95% CI 2.4—4.7) in the left and 1.3 years (95% CI 0.2—2.4) in the right/extreme axis category. Both short and long-term all-cause mortality was lowest in the normal axis category and highest in the right/extreme axis category. Compared to normal axis, both admission phase QRS-axis deviation groups were independently associated with a higher risk of all-cause mortality. When including left ventricular hypertrophy in the ECG, only the right/extreme axis retained its statistical significance (aHR 1.76; 95% CI 1.16—2.66, p = 0.007). Axis shift to another axis category had no effect on mortality. Conclusion: In ACS patients, acute phase QRS-axis deviation was associated with higher risk of all-cause mortality. Among the axis deviation groups, right/extreme QRS-axis deviation was the strongest predictor of mortality in the multivariable analysis. Further studies are required to investigate to what extent this association is caused by pre-existing or by ACS-induced axis deviations. QRS-axis shift during hospital stay had no effect on all-cause mortality.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalJournal of Electrocardiology
Publication statusPublished - 2022
Publication typeA1 Journal article-refereed


  • Acute coronary syndrome
  • ECG
  • Long-term follow-up
  • Mortality
  • Outcome
  • QRS axis

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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