TY - JOUR
T1 - ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes.
T2 - 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.
N1 - 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).
PY - 2007/9
Y1 - 2007/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=34548147895&partnerID=8YFLogxK
U2 - 10.1016/j.jelectrocard.2007.05.008
DO - 10.1016/j.jelectrocard.2007.05.008
M3 - Article
C2 - 17604045
AN - SCOPUS:34548147895
SN - 0022-0736
VL - 40
SP - 408
EP - 415
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
IS - 5
ER -