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Clinical implications of a next-day follow-up electrocardiogram in patients with non-ST elevation acute coronary syndromes.
Am Heart J. 2008 Oct; 156(4):797-803.AH

Abstract

BACKGROUND

The prognostic value of admission ST-segment changes in patients with non-ST elevation acute coronary syndromes (NSTE ACS) is well established; however, the value of a next-day follow-up electrocardiogram (ECG) is unclear.

METHOD

We evaluated ST-depression (ST(downward arrow)) and Q-wave status on the admission and 24 to 36-hour follow-up ECG in 2,743 patients in a prospective Canadian ACS registry.

RESULTS

Of patients with ST(downward arrow) > or =1 mm on admission (n = 533 [19.4%]), 366 (68.7%) normalized their ST segment on follow-up ECG. Among patients without ST(downward arrow) on admission (n = 2,110), 97 (4.4%) developed new ST(downward arrow) at follow-up. Patients with normalized ST(downward arrow) at follow-up had higher 1-year myocardial infarction (MI) (10.1% vs 5.7%, odds ratio [OR] 1.77, 95% CI 1.12-2.81, P = .015) and death/MI rates (19.5% vs 10.2%, OR 1.69, 95% CI 1.18-2.41, P = .004), respectively, as compared to those who never had ST(downward arrow). Patients with persistent ST(downward arrow) had higher 1-year MI (10.8% vs 5.7%, OR 1.95, 95% CI 1.09-3.51, P = .025) and death/MI rates (25.6% vs 10.2%, OR 1.78, 95% CI 1.13-2.79, P = .013), respectively. In multivariable analysis, ST(downward arrow) on baseline ECG was an independent predictor of 1-year mortality; however, ST(downward arrow) on the follow-up ECG did not provide additional prognostic value. There were no differences in outcomes between the 4 different Q-wave status groups.

CONCLUSIONS

Although dynamic and persistent ST(downward arrow) are associated with worse unadjusted outcome in patients with NSTE ACS, there was no incremental prognostic value of a follow-up ECG evaluating ST depression and/or Q-wave status beyond that already provided by the initial ECG together with established prognostic factors.

Authors+Show Affiliations

Terrence Donnelly Heart 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 available

Pub Type(s)

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

Language

eng

PubMed ID

18926163

Citation

Alkaabi, Salem, et al. "Clinical Implications of a Next-day Follow-up Electrocardiogram in Patients With non-ST Elevation Acute Coronary Syndromes." American Heart Journal, vol. 156, no. 4, 2008, pp. 797-803.
Alkaabi S, Baslaib F, Casanova A, et al. Clinical implications of a next-day follow-up electrocardiogram in patients with non-ST elevation acute coronary syndromes. Am Heart J. 2008;156(4):797-803.
Alkaabi, S., Baslaib, F., Casanova, A., Yan, A. T., Fitchett, D., Mendelsohn, A., Nikhil, J. Y., Langer, A., & Goodman, S. G. (2008). Clinical implications of a next-day follow-up electrocardiogram in patients with non-ST elevation acute coronary syndromes. American Heart Journal, 156(4), 797-803. https://doi.org/10.1016/j.ahj.2008.06.014
Alkaabi S, et al. Clinical Implications of a Next-day Follow-up Electrocardiogram in Patients With non-ST Elevation Acute Coronary Syndromes. Am Heart J. 2008;156(4):797-803. PubMed PMID: 18926163.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical implications of a next-day follow-up electrocardiogram in patients with non-ST elevation acute coronary syndromes. AU - Alkaabi,Salem, AU - Baslaib,Fahad, AU - Casanova,Amparo, AU - Yan,Andrew T, AU - Fitchett,David, AU - Mendelsohn,Aurora, AU - Nikhil,Jano Y, AU - Langer,Anatoly, AU - Goodman,Shaun G, AU - ,, Y1 - 2008/08/27/ PY - 2008/01/24/received PY - 2008/06/10/accepted PY - 2008/10/18/pubmed PY - 2008/11/15/medline PY - 2008/10/18/entrez SP - 797 EP - 803 JF - American heart journal JO - Am. Heart J. VL - 156 IS - 4 N2 - BACKGROUND: The prognostic value of admission ST-segment changes in patients with non-ST elevation acute coronary syndromes (NSTE ACS) is well established; however, the value of a next-day follow-up electrocardiogram (ECG) is unclear. METHOD: We evaluated ST-depression (ST(downward arrow)) and Q-wave status on the admission and 24 to 36-hour follow-up ECG in 2,743 patients in a prospective Canadian ACS registry. RESULTS: Of patients with ST(downward arrow) > or =1 mm on admission (n = 533 [19.4%]), 366 (68.7%) normalized their ST segment on follow-up ECG. Among patients without ST(downward arrow) on admission (n = 2,110), 97 (4.4%) developed new ST(downward arrow) at follow-up. Patients with normalized ST(downward arrow) at follow-up had higher 1-year myocardial infarction (MI) (10.1% vs 5.7%, odds ratio [OR] 1.77, 95% CI 1.12-2.81, P = .015) and death/MI rates (19.5% vs 10.2%, OR 1.69, 95% CI 1.18-2.41, P = .004), respectively, as compared to those who never had ST(downward arrow). Patients with persistent ST(downward arrow) had higher 1-year MI (10.8% vs 5.7%, OR 1.95, 95% CI 1.09-3.51, P = .025) and death/MI rates (25.6% vs 10.2%, OR 1.78, 95% CI 1.13-2.79, P = .013), respectively. In multivariable analysis, ST(downward arrow) on baseline ECG was an independent predictor of 1-year mortality; however, ST(downward arrow) on the follow-up ECG did not provide additional prognostic value. There were no differences in outcomes between the 4 different Q-wave status groups. CONCLUSIONS: Although dynamic and persistent ST(downward arrow) are associated with worse unadjusted outcome in patients with NSTE ACS, there was no incremental prognostic value of a follow-up ECG evaluating ST depression and/or Q-wave status beyond that already provided by the initial ECG together with established prognostic factors. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18926163/Clinical_implications_of_a_next_day_follow_up_electrocardiogram_in_patients_with_non_ST_elevation_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00483-3 DB - PRIME DP - Unbound Medicine ER -