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Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes.
Am J Cardiol. 2006 Feb 01; 97(3):334-9.AJ

Abstract

Many studies have shown that ST-segment depression is a strong predictor of poor outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs); however, lead aVR was not considered in these studies. The present study examined the prognostic usefulness of the 12-lead electrocardiogram in combination with biochemical markers in 333 patients with NSTE-ACS. ST-segment deviation of > or =0.5 mm was considered clinically significant. Coronary angiography was performed a median of 3 days after admission in all patients. The primary end point was the composite of death, myocardial infarction, and urgent revascularization at 90 days. ST-segment elevation in lead aVR (odds ratio 13.8, 95% confidence interval 1.43 to 100.9, p = 0.03) and increased troponin T (odds ratio 7.9, 95% confidence interval 1.22 to 123.8, p = 0.04) were the only independent predictors of restricted events (death or myocardial infarction) at 90 days. ST-segment elevation in lead aVR (odds ratio 12.8, 95% confidence interval 4.80 to 33.9, p < 0.0001) and increased troponin T (odds ratio 2.03, 95% confidence interval 1.20 to 4.29, p = 0.04) were also the only independent predictors of adverse events (death, myocardial infarction, or urgent revascularization) at 90 days. When ST-segment status in lead aVR was combined with troponin T, patients with ST-segment elevation in lead aVR and increased troponin T had the highest rates of left main or 3-vessel coronary disease (62%) and 90-day adverse outcomes (47%). In conclusion, our findings suggest that ST-segment status in lead aVR combined with troponin T on admission is a simple and useful clinical tool for early risk stratification in patients with NSTE-ACS.

Authors+Show Affiliations

The Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.No 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16442391

Citation

Kosuge, Masami, et al. "Combined Prognostic Utility of ST Segment in Lead aVR and Troponin T On Admission in non-ST-segment Elevation Acute Coronary Syndromes." The American Journal of Cardiology, vol. 97, no. 3, 2006, pp. 334-9.
Kosuge M, Kimura K, Ishikawa T, et al. Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes. Am J Cardiol. 2006;97(3):334-9.
Kosuge, M., Kimura, K., Ishikawa, T., Ebina, T., Hibi, K., Tsukahara, K., Kanna, M., Iwahashi, N., Okuda, J., Nozawa, N., Ozaki, H., Yano, H., Kusama, I., & Umemura, S. (2006). Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes. The American Journal of Cardiology, 97(3), 334-9.
Kosuge M, et al. Combined Prognostic Utility of ST Segment in Lead aVR and Troponin T On Admission in non-ST-segment Elevation Acute Coronary Syndromes. Am J Cardiol. 2006 Feb 1;97(3):334-9. PubMed PMID: 16442391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes. AU - Kosuge,Masami, AU - Kimura,Kazuo, AU - Ishikawa,Toshiyuki, AU - Ebina,Toshiaki, AU - Hibi,Kiyoshi, AU - Tsukahara,Kengo, AU - Kanna,Masahiko, AU - Iwahashi,Noriaki, AU - Okuda,Jyun, AU - Nozawa,Naoki, AU - Ozaki,Hiroyuki, AU - Yano,Hideto, AU - Kusama,Ikuyoshi, AU - Umemura,Satoshi, PY - 2005/07/07/received PY - 2005/08/12/revised PY - 2005/08/12/accepted PY - 2006/1/31/pubmed PY - 2006/4/6/medline PY - 2006/1/31/entrez SP - 334 EP - 9 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 97 IS - 3 N2 - Many studies have shown that ST-segment depression is a strong predictor of poor outcomes in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs); however, lead aVR was not considered in these studies. The present study examined the prognostic usefulness of the 12-lead electrocardiogram in combination with biochemical markers in 333 patients with NSTE-ACS. ST-segment deviation of > or =0.5 mm was considered clinically significant. Coronary angiography was performed a median of 3 days after admission in all patients. The primary end point was the composite of death, myocardial infarction, and urgent revascularization at 90 days. ST-segment elevation in lead aVR (odds ratio 13.8, 95% confidence interval 1.43 to 100.9, p = 0.03) and increased troponin T (odds ratio 7.9, 95% confidence interval 1.22 to 123.8, p = 0.04) were the only independent predictors of restricted events (death or myocardial infarction) at 90 days. ST-segment elevation in lead aVR (odds ratio 12.8, 95% confidence interval 4.80 to 33.9, p < 0.0001) and increased troponin T (odds ratio 2.03, 95% confidence interval 1.20 to 4.29, p = 0.04) were also the only independent predictors of adverse events (death, myocardial infarction, or urgent revascularization) at 90 days. When ST-segment status in lead aVR was combined with troponin T, patients with ST-segment elevation in lead aVR and increased troponin T had the highest rates of left main or 3-vessel coronary disease (62%) and 90-day adverse outcomes (47%). In conclusion, our findings suggest that ST-segment status in lead aVR combined with troponin T on admission is a simple and useful clinical tool for early risk stratification in patients with NSTE-ACS. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/16442391/Combined_prognostic_utility_of_ST_segment_in_lead_aVR_and_troponin_T_on_admission_in_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)01819-9 DB - PRIME DP - Unbound Medicine ER -