BACKGROUND: Patients with non-ST-segment elevation acute coronary syndromes constitute a heterogeneous group concerning prognosis. The 12-lead ECG at rest is recommended for early risk stratification but is unable to reflect the dynamic nature of myocardial ischemia and coronary thrombosis. This study investigated whether continuous ST-segment monitoring provides early prognostic information in such patients. METHODS: We prospectively studied 183 patients admitted due to chest pain at rest suggestive of an acute coronary syndrome. ST-segment monitoring was performed continuously for 24 hours from admission. Cardiac-specific troponin I levels were determined on admission and every 6 hours for the first 24 hours. The endpoint was defined as death or nonfatal myocardial infarction, whichever occurred first by 30 days follow-up. RESULTS: ST episodes, defined as transient ST deviations of at least 0.1 mV, were detected in 50 patients (27.3%) and associated with worse 30-day outcome: 22.0% endpoint rate compared to 6.8% for patients without ST episodes (P = 0.003). In a multivariate analysis, the presence of ST episodes (hazard ratio, 3.07; 95% CI, 1.26 to 7.46; P = 0.014) and peak troponin I levels > 0.2 microg/L (hazard ratio, 2.65; 95% CI, 1.01 to 6.95; P = 0.048) were independent predictors of prognosis. The combination of ST-segment monitoring and peak troponin I identified patients at low (2.5%, n = 79), intermediate (14.5%, n = 76), and high (25.0%, n = 28) risk for the 30-day endpoint. CONCLUSIONS: In patients with non-ST-segment elevation acute coronary syndromes, continuous ST-segment monitoring provides on-line early prognostic information, in addition to troponin I levels.
BACKGROUND:Patients with non-ST-segment elevation acute coronary syndromes constitute a heterogeneous group concerning prognosis. The 12-lead ECG at rest is recommended for early risk stratification but is unable to reflect the dynamic nature of myocardial ischemia and coronary thrombosis. This study investigated whether continuous ST-segment monitoring provides early prognostic information in such patients. METHODS: We prospectively studied 183 patients admitted due to chest pain at rest suggestive of an acute coronary syndrome. ST-segment monitoring was performed continuously for 24 hours from admission. Cardiac-specific troponin I levels were determined on admission and every 6 hours for the first 24 hours. The endpoint was defined as death or nonfatal myocardial infarction, whichever occurred first by 30 days follow-up. RESULTS: ST episodes, defined as transient ST deviations of at least 0.1 mV, were detected in 50 patients (27.3%) and associated with worse 30-day outcome: 22.0% endpoint rate compared to 6.8% for patients without ST episodes (P = 0.003). In a multivariate analysis, the presence of ST episodes (hazard ratio, 3.07; 95% CI, 1.26 to 7.46; P = 0.014) and peak troponin I levels > 0.2 microg/L (hazard ratio, 2.65; 95% CI, 1.01 to 6.95; P = 0.048) were independent predictors of prognosis. The combination of ST-segment monitoring and peak troponin I identified patients at low (2.5%, n = 79), intermediate (14.5%, n = 76), and high (25.0%, n = 28) risk for the 30-day endpoint. CONCLUSIONS: In patients with non-ST-segment elevation acute coronary syndromes, continuous ST-segment monitoring provides on-line early prognostic information, in addition to troponin I levels.
Authors: D J Patel; C J Knight; D R Holdright; D Mulcahy; D Clarke; C Wright; H Purcell; K M Fox Journal: Circulation Date: 1997-03-04 Impact factor: 29.690
Authors: K M Akkerhuis; A C Maas; P A Klootwijk; M W Krucoff; S Meij; R M Califf; M L Simoons Journal: J Electrocardiol Date: 2000-04 Impact factor: 1.438
Authors: E M Antman; M J Tanasijevic; B Thompson; M Schactman; C H McCabe; C P Cannon; G A Fischer; A Y Fung; C Thompson; D Wybenga; E Braunwald Journal: N Engl J Med Date: 1996-10-31 Impact factor: 91.245
Authors: J B Gill; J A Cairns; R S Roberts; L Costantini; B J Sealey; E F Fallen; C W Tomlinson; M Gent Journal: N Engl J Med Date: 1996-01-11 Impact factor: 91.245
Authors: J E Calvin; L W Klein; B J VandenBerg; P Meyer; J V Condon; R J Snell; L M Ramirez-Morgen; J E Parrillo Journal: JAMA Date: 1995-01-11 Impact factor: 56.272