Tags

Type your tag names separated by a space and hit enter

Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes.
Eur Heart J. 2005 Oct; 26(20):2106-13.EH

Abstract

AIMS

We sought to determine whether the extent of myocardial ischaemia on the admission electrocardiogram (ECG) has independent predictive value for short-term risk stratification of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). Although the presence of ischaemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined.

METHODS AND RESULTS

We analysed the admission ECGs of 5192 ACS patients enrolled in the GUSTO-IIb trial, without an ECG indication for thrombolysis. ECG tracings showing one or more of the following were eligible: ST-segment depression >0.5 mm, T-wave inversion >1 mm, and ST-segment elevation >0.5 mm but <1 mm. ECG variables associated with unfavourable 30 day outcomes in a univariable analysis were further assessed in a multivariable logistic regression model including independent clinical predictors. In the multivariable clinical, enzymatic, and ECG model, the sum of ST-segment depression (in millimetres) in all leads was a powerful independent predictor of 30 day death (P<0.0001), with a continuous increase in risk with the extent of ST-segment depression. The sum of ST-segment depression (P<0.0001) and the presence of minimal inferior ST-segment elevation (P<0.0001) or anterior ST-segment elevation (P=0.0182) were also independent predictors of the composite of death and myocardial infarction or reinfarction. The extent of ST-segment depression showed a highly significant correlation with the prevalence of three-vessel (P<0.0001) or left main coronary disease (P<0.0001), and also with the peak levels of creatine kinase (P<0.0001) during the index episode of ACS.

CONCLUSION

In patients with NSTE ACS, the sum of ST-segment depression in all ECG leads is a powerful predictor of all-cause mortality at 30 days, independent of clinical variables and correlates with the extent and severity of coronary artery disease. The presence of even minimal (<1 mm) ST-segment elevation in anterior or inferior leads is independently associated with adverse outcomes.

Authors+Show Affiliations

Dipartimento Cardio-toraco-vascolare, 'A. De Gasperis', Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy. stefano.savonitto@fastwebnet.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

15987706

Citation

Savonitto, Stefano, et al. "Extent of ST-segment Depression and Cardiac Events in non-ST-segment Elevation Acute Coronary Syndromes." European Heart Journal, vol. 26, no. 20, 2005, pp. 2106-13.
Savonitto S, Cohen MG, Politi A, et al. Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2005;26(20):2106-13.
Savonitto, S., Cohen, M. G., Politi, A., Hudson, M. P., Kong, D. F., Huang, Y., Pieper, K. S., Mauri, F., Wagner, G. S., Califf, R. M., Topol, E. J., & Granger, C. B. (2005). Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. European Heart Journal, 26(20), 2106-13.
Savonitto S, et al. Extent of ST-segment Depression and Cardiac Events in non-ST-segment Elevation Acute Coronary Syndromes. Eur Heart J. 2005;26(20):2106-13. PubMed PMID: 15987706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. AU - Savonitto,Stefano, AU - Cohen,Mauricio G, AU - Politi,Alessandro, AU - Hudson,Michael P, AU - Kong,David F, AU - Huang,Yao, AU - Pieper,Karen S, AU - Mauri,Francesco, AU - Wagner,Galen S, AU - Califf,Robert M, AU - Topol,Eric J, AU - Granger,Christopher B, Y1 - 2005/06/29/ PY - 2005/7/1/pubmed PY - 2006/3/22/medline PY - 2005/7/1/entrez SP - 2106 EP - 13 JF - European heart journal JO - Eur. Heart J. VL - 26 IS - 20 N2 - AIMS: We sought to determine whether the extent of myocardial ischaemia on the admission electrocardiogram (ECG) has independent predictive value for short-term risk stratification of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). Although the presence of ischaemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. METHODS AND RESULTS: We analysed the admission ECGs of 5192 ACS patients enrolled in the GUSTO-IIb trial, without an ECG indication for thrombolysis. ECG tracings showing one or more of the following were eligible: ST-segment depression >0.5 mm, T-wave inversion >1 mm, and ST-segment elevation >0.5 mm but <1 mm. ECG variables associated with unfavourable 30 day outcomes in a univariable analysis were further assessed in a multivariable logistic regression model including independent clinical predictors. In the multivariable clinical, enzymatic, and ECG model, the sum of ST-segment depression (in millimetres) in all leads was a powerful independent predictor of 30 day death (P<0.0001), with a continuous increase in risk with the extent of ST-segment depression. The sum of ST-segment depression (P<0.0001) and the presence of minimal inferior ST-segment elevation (P<0.0001) or anterior ST-segment elevation (P=0.0182) were also independent predictors of the composite of death and myocardial infarction or reinfarction. The extent of ST-segment depression showed a highly significant correlation with the prevalence of three-vessel (P<0.0001) or left main coronary disease (P<0.0001), and also with the peak levels of creatine kinase (P<0.0001) during the index episode of ACS. CONCLUSION: In patients with NSTE ACS, the sum of ST-segment depression in all ECG leads is a powerful predictor of all-cause mortality at 30 days, independent of clinical variables and correlates with the extent and severity of coronary artery disease. The presence of even minimal (<1 mm) ST-segment elevation in anterior or inferior leads is independently associated with adverse outcomes. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15987706/Extent_of_ST_segment_depression_and_cardiac_events_in_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi395 DB - PRIME DP - Unbound Medicine ER -