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

Fons Windhausen*, Alexander Hirsch, Jan G.P. Tijssen, Jan Hein Cornel, Freek W.A. Verheugt, Margriet I. Klees, Robbert J. de Winter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)

Abstract

Background: We assessed the prognostic significance of the presence of cumulative (∑) 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 ∑ ST-segment deviation of at least 1 mm. Results: The incidence of death or myocardial infarction (MI) by 1 year in patients with ∑ ST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with ∑ ST-segment deviation of less than 1 mm (P = .001). Among patients with ∑ ST-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 ∑ ST-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 ∑ ST-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.

Original languageEnglish
Pages (from-to)408-415
Number of pages8
JournalJournal of Electrocardiology
Volume40
Issue number5
DOIs
Publication statusPublished - Sept 2007
Externally publishedYes

Bibliographical note

Financial support: The Invasive versus Conservative Treatment in Unstable coronary Syndromes study was supported by the Interuniversitary Cardiology Institute of the Netherlands (Utrecht, The Netherlands), the Working group on Cardiovascular Research of the Netherlands (Utrecht, The Netherlands), and educational grants from Eli Lilly (Houten, The Netherlands), Sanofi/Synthelabo (Gouda, The Netherlands), Aventis (Gouda, The Netherlands), Pfizer (Capelle a/d I Jsel, The Netherlands), and Medtronic (Heerlen, The Netherlands).

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