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ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial.
J Electrocardiol. 2007 Sep-Oct; 40(5):408-15.JE

Abstract

BACKGROUND

We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive treatment strategy.

METHODS

A 12-lead ECG obtained at admission was available for analysis from 1163 patients. The presence and magnitude of ST-segment deviation was measured in each lead, and absolute ST-segment deviation was summed. The effect of treatment strategy was assessed for patients with or without SigmaST-segment deviation of at least 1 mm.

RESULTS

The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 mm, the incidence of death or MI was 21.9% in the early invasive group compared with 14.2% in SI group (P < .01). However, we observed a significantly higher rate of MI after hospital discharge among patients with SigmaST-segment deviation of at least 1 mm randomized to SI who did not undergo angiography compared with patients who underwent angiography before discharge (10.9% vs 2.4%, P = .003). In a forward logistic regression analysis, the presence of ST-segment deviation was an independent predictor for failure of medical therapy (coronary angiography within 30 days after randomization in the SI group) (odds ratio, 1.56; 95% confidence interval, 1.12-2.18; P = .009).

CONCLUSION

Patients with non-ST-elevation acute coronary syndrome and an elevated troponin T and SigmaST-segment deviation of at least 1 mm are at increased risk of death or MI, more often fail on medical therapy, and more often experience a spontaneous MI after discharge when angiography was not performed during initial hospitalization.

Authors+Show Affiliations

Department of Cardiology of the Academic Medical Center, Amsterdam, The Netherlands. a.windhausen@amc.uva.nl <a.windhausen@amc.uva.nl>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
Randomized Controlled Trial

Language

eng

PubMed ID

17604045

Citation

Windhausen, Fons, et al. "ST-segment Deviation On the Admission Electrocardiogram, Treatment Strategy, and Outcome in non-ST-elevation Acute Coronary Syndromes a Substudy of the Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Trial." Journal of Electrocardiology, vol. 40, no. 5, 2007, pp. 408-15.
Windhausen F, Hirsch A, Tijssen JG, et al. ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial. J Electrocardiol. 2007;40(5):408-15.
Windhausen, F., Hirsch, A., Tijssen, J. G., Cornel, J. H., Verheugt, F. W., Klees, M. I., & de Winter, R. J. (2007). ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial. Journal of Electrocardiology, 40(5), 408-15.
Windhausen F, et al. ST-segment Deviation On the Admission Electrocardiogram, Treatment Strategy, and Outcome in non-ST-elevation Acute Coronary Syndromes a Substudy of the Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Trial. J Electrocardiol. 2007 Sep-Oct;40(5):408-15. PubMed PMID: 17604045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial. AU - Windhausen,Fons, AU - Hirsch,Alexander, AU - Tijssen,Jan G P, AU - Cornel,Jan Hein, AU - Verheugt,Freek W A, AU - Klees,Margriet I, AU - de Winter,Robbert J, AU - ,, Y1 - 2007/07/02/ PY - 2007/03/18/received PY - 2007/05/11/accepted PY - 2007/7/3/pubmed PY - 2007/9/25/medline PY - 2007/7/3/entrez SP - 408 EP - 15 JF - Journal of electrocardiology JO - J Electrocardiol VL - 40 IS - 5 N2 - BACKGROUND: We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive treatment strategy. METHODS: A 12-lead ECG obtained at admission was available for analysis from 1163 patients. The presence and magnitude of ST-segment deviation was measured in each lead, and absolute ST-segment deviation was summed. The effect of treatment strategy was assessed for patients with or without SigmaST-segment deviation of at least 1 mm. RESULTS: The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 mm, the incidence of death or MI was 21.9% in the early invasive group compared with 14.2% in SI group (P < .01). However, we observed a significantly higher rate of MI after hospital discharge among patients with SigmaST-segment deviation of at least 1 mm randomized to SI who did not undergo angiography compared with patients who underwent angiography before discharge (10.9% vs 2.4%, P = .003). In a forward logistic regression analysis, the presence of ST-segment deviation was an independent predictor for failure of medical therapy (coronary angiography within 30 days after randomization in the SI group) (odds ratio, 1.56; 95% confidence interval, 1.12-2.18; P = .009). CONCLUSION: Patients with non-ST-elevation acute coronary syndrome and an elevated troponin T and SigmaST-segment deviation of at least 1 mm are at increased risk of death or MI, more often fail on medical therapy, and more often experience a spontaneous MI after discharge when angiography was not performed during initial hospitalization. SN - 1532-8430 UR - https://www.unboundmedicine.com/medline/citation/17604045/ST_segment_deviation_on_the_admission_electrocardiogram_treatment_strategy_and_outcome_in_non_ST_elevation_acute_coronary_syndromes_A_substudy_of_the_Invasive_versus_Conservative_Treatment_in_Unstable_coronary_Syndromes__ICTUS__Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-0736(07)00366-4 DB - PRIME DP - Unbound Medicine ER -