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ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification.
Am Heart J. 2006 Aug; 152(2):270-6.AH

Abstract

BACKGROUND

It is unclear whether quantitative ST-segment assessment can improve risk stratification of unselected acute coronary syndrome (ACS) patients using the validated Global Registry of Acute Cardiac Events (GRACE) risk model.

METHODS

In the prospective, multicenter, Canadian ACS Registry, the admission electrocardiogram was evaluated centrally at a blinded core laboratory. Patients with ST-elevation myocardial infarction and other electrocardiogram confounders were excluded. ST depression (ST down) was measured and summed in all leads except aVR. Patients with ST down were divided into 3 groups based on tertiles of cumulative ST down. A multivariable model was developed to examine the independent prognostic value of ST down severity after adjusting for other known prognosticators in the GRACE risk model.

RESULTS

Among 2590 patients with non-ST-elevation ACS, more severe ST down was associated with advanced age, higher heart rate and Killip class, elevated creatinine, abnormal biomarkers, higher GRACE risk score, and higher 1-year mortality (all P < .001). After adjusting for these confounding prognosticators, the presence of any ST down remained independently associated with higher 1-year mortality (odds ratio 1.78, 95% CI 1.21-2.63, P = .004). However, the gradient of risk with increasing magnitude of ST down was no longer evident (adjusted odds ratios 1.77, 1.77, 1.81, for ascending tertiles of cumulative ST down, respectively). Moreover, quantitative ST down did not improve the model discrimination for 1-year mortality. The results were similar when the number of leads with ST down or the maximum magnitude of ST down was analyzed, after adjusting for tertiles of GRACE risk score or inhospital revascularization, or using the composite end point of death or myocardial (re)infarction at 1 year.

CONCLUSIONS

Greater ST down is associated with other adverse prognosticators across the broad spectrum of non-ST-elevation ACS. Although the presence of any ST down is an independent predictor of 1-year mortality, its quantitative assessment is not as important as its mere presence when studied on the background of comprehensive clinical and biomarker evaluation in a nonclinical trial-based ACS population.

Authors+Show Affiliations

Canadian Heart Research Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.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 available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16875907

Citation

Yan, Andrew T., et al. "ST-segment Depression in non-ST Elevation Acute Coronary Syndromes: Quantitative Analysis May Not Provide Incremental Prognostic Value Beyond Comprehensive Risk Stratification." American Heart Journal, vol. 152, no. 2, 2006, pp. 270-6.
Yan AT, Yan RT, Tan M, et al. ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification. Am Heart J. 2006;152(2):270-6.
Yan, A. T., Yan, R. T., Tan, M., Chow, C. M., Fitchett, D. H., Georgescu, A. A., Hassan, Q., Luchansky, J., Langer, A., & Goodman, S. G. (2006). ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification. American Heart Journal, 152(2), 270-6.
Yan AT, et al. ST-segment Depression in non-ST Elevation Acute Coronary Syndromes: Quantitative Analysis May Not Provide Incremental Prognostic Value Beyond Comprehensive Risk Stratification. Am Heart J. 2006;152(2):270-6. PubMed PMID: 16875907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification. AU - Yan,Andrew T, AU - Yan,Raymond T, AU - Tan,Mary, AU - Chow,Chi-Ming, AU - Fitchett,David H, AU - Georgescu,Alina A, AU - Hassan,Quamrul, AU - Luchansky,Janna, AU - Langer,Anatoly, AU - Goodman,Shaun G, AU - ,, PY - 2005/08/08/received PY - 2005/12/06/accepted PY - 2006/8/1/pubmed PY - 2006/9/20/medline PY - 2006/8/1/entrez SP - 270 EP - 6 JF - American heart journal JO - Am. Heart J. VL - 152 IS - 2 N2 - BACKGROUND: It is unclear whether quantitative ST-segment assessment can improve risk stratification of unselected acute coronary syndrome (ACS) patients using the validated Global Registry of Acute Cardiac Events (GRACE) risk model. METHODS: In the prospective, multicenter, Canadian ACS Registry, the admission electrocardiogram was evaluated centrally at a blinded core laboratory. Patients with ST-elevation myocardial infarction and other electrocardiogram confounders were excluded. ST depression (ST down) was measured and summed in all leads except aVR. Patients with ST down were divided into 3 groups based on tertiles of cumulative ST down. A multivariable model was developed to examine the independent prognostic value of ST down severity after adjusting for other known prognosticators in the GRACE risk model. RESULTS: Among 2590 patients with non-ST-elevation ACS, more severe ST down was associated with advanced age, higher heart rate and Killip class, elevated creatinine, abnormal biomarkers, higher GRACE risk score, and higher 1-year mortality (all P < .001). After adjusting for these confounding prognosticators, the presence of any ST down remained independently associated with higher 1-year mortality (odds ratio 1.78, 95% CI 1.21-2.63, P = .004). However, the gradient of risk with increasing magnitude of ST down was no longer evident (adjusted odds ratios 1.77, 1.77, 1.81, for ascending tertiles of cumulative ST down, respectively). Moreover, quantitative ST down did not improve the model discrimination for 1-year mortality. The results were similar when the number of leads with ST down or the maximum magnitude of ST down was analyzed, after adjusting for tertiles of GRACE risk score or inhospital revascularization, or using the composite end point of death or myocardial (re)infarction at 1 year. CONCLUSIONS: Greater ST down is associated with other adverse prognosticators across the broad spectrum of non-ST-elevation ACS. Although the presence of any ST down is an independent predictor of 1-year mortality, its quantitative assessment is not as important as its mere presence when studied on the background of comprehensive clinical and biomarker evaluation in a nonclinical trial-based ACS population. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16875907/ST_segment_depression_in_non_ST_elevation_acute_coronary_syndromes:_quantitative_analysis_may_not_provide_incremental_prognostic_value_beyond_comprehensive_risk_stratification_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)01074-4 DB - PRIME DP - Unbound Medicine ER -