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Long-term prognostic value and therapeutic implications of continuous ST-segment monitoring in acute coronary syndrome.
Am Heart J. 2007 Apr; 153(4):500-6.AH

Abstract

BACKGROUND

In patients with acute coronary syndromes (ACS), recurrent ischemia detected by continuous electrocardiographic monitoring portends a poor outcome. We sought to investigate (1) the additional long-term prognostic value of ST-segment monitoring beyond the validated Global Registry of Acute Coronary Events (GRACE) risk score in ACS and (2) whether ST-segment monitoring can identify patients who benefit from early revascularization.

METHODS

We determined the GRACE risk score (a validated predictor of inhospital mortality) in 681 non-ST-elevation ACS patients enrolled in the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment trial. Continuous ST-segment monitoring in the first 48 hours was analyzed by an automated algorithm and reviewed by a blinded cardiologist. Clinical outcomes were centrally adjudicated in a blinded fashion.

RESULTS

ST-segment shifts were present in 19.1% of 681 patients. After a median follow-up of 30 months, patients with ST-segment shifts had a higher risk of death (17.7% vs 5.8%, log-rank P < .001) and death or myocardial infarction (MI) (24.6% vs 11.1%, log-rank P < .001). In multivariable analysis adjusting for GRACE risk score, the presence of ST-segment shifts remained an independent predictor of death (adjusted hazard ratio = 2.37, 95% CI 1.38-4.09, P = .002) and death/MI (adjusted hazard ratio = 1.93, 95% CI 1.25-3.00, P = .003). Inhospital revascularization was independently associated with a lower risk of death/MI among patients with ST-segment shifts but not among those without (P for interaction = .02).

CONCLUSIONS

Continuous ST-segment monitoring provides incremental prognostic information beyond the validated GRACE risk score determined on presentation and identifies high-risk patients who benefit from early revascularization. This simple and valuable clinical tool may be useful in the routine management of ACS.

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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17383285

Citation

Yan, Andrew T., et al. "Long-term Prognostic Value and Therapeutic Implications of Continuous ST-segment Monitoring in Acute Coronary Syndrome." American Heart Journal, vol. 153, no. 4, 2007, pp. 500-6.
Yan AT, Yan RT, Tan M, et al. Long-term prognostic value and therapeutic implications of continuous ST-segment monitoring in acute coronary syndrome. Am Heart J. 2007;153(4):500-6.
Yan, A. T., Yan, R. T., Tan, M., Senaratne, M., Fitchett, D. H., Langer, A., & Goodman, S. G. (2007). Long-term prognostic value and therapeutic implications of continuous ST-segment monitoring in acute coronary syndrome. American Heart Journal, 153(4), 500-6.
Yan AT, et al. Long-term Prognostic Value and Therapeutic Implications of Continuous ST-segment Monitoring in Acute Coronary Syndrome. Am Heart J. 2007;153(4):500-6. PubMed PMID: 17383285.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term prognostic value and therapeutic implications of continuous ST-segment monitoring in acute coronary syndrome. AU - Yan,Andrew T, AU - Yan,Raymond T, AU - Tan,Mary, AU - Senaratne,Mano, AU - Fitchett,David H, AU - Langer,Anatoly, AU - Goodman,Shaun G, AU - ,, PY - 2007/01/03/received PY - 2007/02/02/accepted PY - 2007/3/27/pubmed PY - 2007/5/4/medline PY - 2007/3/27/entrez SP - 500 EP - 6 JF - American heart journal JO - Am Heart J VL - 153 IS - 4 N2 - BACKGROUND: In patients with acute coronary syndromes (ACS), recurrent ischemia detected by continuous electrocardiographic monitoring portends a poor outcome. We sought to investigate (1) the additional long-term prognostic value of ST-segment monitoring beyond the validated Global Registry of Acute Coronary Events (GRACE) risk score in ACS and (2) whether ST-segment monitoring can identify patients who benefit from early revascularization. METHODS: We determined the GRACE risk score (a validated predictor of inhospital mortality) in 681 non-ST-elevation ACS patients enrolled in the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment trial. Continuous ST-segment monitoring in the first 48 hours was analyzed by an automated algorithm and reviewed by a blinded cardiologist. Clinical outcomes were centrally adjudicated in a blinded fashion. RESULTS: ST-segment shifts were present in 19.1% of 681 patients. After a median follow-up of 30 months, patients with ST-segment shifts had a higher risk of death (17.7% vs 5.8%, log-rank P < .001) and death or myocardial infarction (MI) (24.6% vs 11.1%, log-rank P < .001). In multivariable analysis adjusting for GRACE risk score, the presence of ST-segment shifts remained an independent predictor of death (adjusted hazard ratio = 2.37, 95% CI 1.38-4.09, P = .002) and death/MI (adjusted hazard ratio = 1.93, 95% CI 1.25-3.00, P = .003). Inhospital revascularization was independently associated with a lower risk of death/MI among patients with ST-segment shifts but not among those without (P for interaction = .02). CONCLUSIONS: Continuous ST-segment monitoring provides incremental prognostic information beyond the validated GRACE risk score determined on presentation and identifies high-risk patients who benefit from early revascularization. This simple and valuable clinical tool may be useful in the routine management of ACS. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/17383285/Long_term_prognostic_value_and_therapeutic_implications_of_continuous_ST_segment_monitoring_in_acute_coronary_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00125-1 DB - PRIME DP - Unbound Medicine ER -