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Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials).
Am J Cardiol. 2012 Jan 01; 109(1):6-12.AJ

Abstract

The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data, were included in this analysis. The main outcome was 5-year cardiovascular death or myocardial infarction. Hazard ratios (HRs) were calculated with Cox regression models, and adjustments were made for established outcome predictors. The additional discriminative value was assessed with the category-less net reclassification improvement and integrated discrimination improvement indexes. In the 5,420 patients, the presence of ST-segment depression (≥1 mm; adjusted HR 1.43, 95% confidence interval [CI] 1.25 to 1.63) and left bundle branch block (adjusted HR 1.64, 95% CI 1.18 to 2.28) were independently associated with long-term cardiovascular death or myocardial infarction. Risk increases were short and long term. On quantitative ECG analysis, cumulative ST-segment depression (≥5 mm; adjusted HR 1.34, 95% CI 1.05 to 1.70), the presence of left bundle branch block (adjusted HR 2.15, 95% CI 1.36 to 3.40) or ≥6 leads with inverse T waves (adjusted HR 1.22, 95% CI 0.97 to 1.55) was independently associated with long-term outcomes. No interaction was observed with treatment strategy. No improvements in net reclassification improvement and integrated discrimination improvement were observed after the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set, admission ECG characteristics provided long-term prognostic value for cardiovascular death or myocardial infarction. Quantitative ECG characteristics provided no incremental discrimination compared to qualitative data.

Authors+Show Affiliations

Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.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)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21944677

Citation

Damman, Peter, et al. "Usefulness of the Admission Electrocardiogram to Predict Long-term Outcomes After non-ST-elevation Acute Coronary Syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials)." The American Journal of Cardiology, vol. 109, no. 1, 2012, pp. 6-12.
Damman P, Holmvang L, Tijssen JG, et al. Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials). Am J Cardiol. 2012;109(1):6-12.
Damman, P., Holmvang, L., Tijssen, J. G., Lagerqvist, B., Clayton, T. C., Pocock, S. J., Windhausen, F., Hirsch, A., Fox, K. A., Wallentin, L., & de Winter, R. J. (2012). Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials). The American Journal of Cardiology, 109(1), 6-12. https://doi.org/10.1016/j.amjcard.2011.08.002
Damman P, et al. Usefulness of the Admission Electrocardiogram to Predict Long-term Outcomes After non-ST-elevation Acute Coronary Syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials). Am J Cardiol. 2012 Jan 1;109(1):6-12. PubMed PMID: 21944677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of the admission electrocardiogram to predict long-term outcomes after non-ST-elevation acute coronary syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials). AU - Damman,Peter, AU - Holmvang,Lene, AU - Tijssen,Jan G P, AU - Lagerqvist,Bo, AU - Clayton,Tim C, AU - Pocock,Stuart J, AU - Windhausen,Fons, AU - Hirsch,Alexander, AU - Fox,Keith A A, AU - Wallentin,Lars, AU - de Winter,Robbert J, Y1 - 2011/09/23/ PY - 2011/07/14/received PY - 2011/08/08/revised PY - 2011/08/08/accepted PY - 2011/9/28/entrez PY - 2011/9/29/pubmed PY - 2012/2/9/medline SP - 6 EP - 12 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 109 IS - 1 N2 - The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data, were included in this analysis. The main outcome was 5-year cardiovascular death or myocardial infarction. Hazard ratios (HRs) were calculated with Cox regression models, and adjustments were made for established outcome predictors. The additional discriminative value was assessed with the category-less net reclassification improvement and integrated discrimination improvement indexes. In the 5,420 patients, the presence of ST-segment depression (≥1 mm; adjusted HR 1.43, 95% confidence interval [CI] 1.25 to 1.63) and left bundle branch block (adjusted HR 1.64, 95% CI 1.18 to 2.28) were independently associated with long-term cardiovascular death or myocardial infarction. Risk increases were short and long term. On quantitative ECG analysis, cumulative ST-segment depression (≥5 mm; adjusted HR 1.34, 95% CI 1.05 to 1.70), the presence of left bundle branch block (adjusted HR 2.15, 95% CI 1.36 to 3.40) or ≥6 leads with inverse T waves (adjusted HR 1.22, 95% CI 0.97 to 1.55) was independently associated with long-term outcomes. No interaction was observed with treatment strategy. No improvements in net reclassification improvement and integrated discrimination improvement were observed after the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set, admission ECG characteristics provided long-term prognostic value for cardiovascular death or myocardial infarction. Quantitative ECG characteristics provided no incremental discrimination compared to qualitative data. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/21944677/Usefulness_of_the_admission_electrocardiogram_to_predict_long_term_outcomes_after_non_ST_elevation_acute_coronary_syndrome__from_the_FRISC_II_ICTUS_and_RITA_3_[FIR]_Trials__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(11)02540-9 DB - PRIME DP - Unbound Medicine ER -