OBJECTIVE: To determine the associations between changes on the presenting ECG, in-hospital revascularisation, and four year mortality in patients with non-ST elevation acute coronary syndromes. DESIGN: Prospective evaluation of all consecutive patients admitted in 1993 to the Green Lane Hospital coronary care unit, Auckland, New Zealand. Late follow up was undertaken at a median of 52 months. The ECGs were analysed after the hospital admission. SETTING: Tertiary referral centre with direct local coronary care unit admissions. INTERVENTIONS: Patients underwent physician recommended in-hospital revascularisation or initial conservative management. RESULTS: The four year survival was 88% in the 115 patients who underwent revascularisation (65 (19%) percutaneous and 53 (16%) surgical revascularisation), compared with 75% in 316 patients managed conservatively (p = 0.024). Four year survival for patients undergoing revascularisation versus initial conservative management with respect to ECG groups was: no ECG changes (n = 101), 97% v 92% (p = 0.35); T wave inversion or 0.5 mm ST depression (n = 108), 89% v 78% (p = 0.18); ST depression > or = 1 mm (n = 122), 80% v 58% (p = 0.014); chi2 = 29, p < 0.001 for the linear trend across the groups. On multivariate analysis, independent predictors of four year mortality were: age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.08; p = 0.0046); ECG group (OR 1.88, 95% CI 1.21 to 2.95; p = 0.043); radiological pulmonary oedema (OR 2.81, 95% CI 1.18 to 7.05; p = 0.025); and revascularisation (OR 0.43, 95% CI 0.20 to 0.90; p = 0.023). CONCLUSIONS: Among unselected patients with non-ST elevation acute coronary syndromes, in-hospital revascularisation is associated with decreased mortality at up to four years after admission. This association appears greater in patients with ST depression of > or = 1 mm on the presenting ECG.
OBJECTIVE: To determine the associations between changes on the presenting ECG, in-hospital revascularisation, and four year mortality in patients with non-ST elevation acute coronary syndromes. DESIGN: Prospective evaluation of all consecutive patients admitted in 1993 to the Green Lane Hospital coronary care unit, Auckland, New Zealand. Late follow up was undertaken at a median of 52 months. The ECGs were analysed after the hospital admission. SETTING: Tertiary referral centre with direct local coronary care unit admissions. INTERVENTIONS:Patients underwent physician recommended in-hospital revascularisation or initial conservative management. RESULTS: The four year survival was 88% in the 115 patients who underwent revascularisation (65 (19%) percutaneous and 53 (16%) surgical revascularisation), compared with 75% in 316 patients managed conservatively (p = 0.024). Four year survival for patients undergoing revascularisation versus initial conservative management with respect to ECG groups was: no ECG changes (n = 101), 97% v 92% (p = 0.35); T wave inversion or 0.5 mm ST depression (n = 108), 89% v 78% (p = 0.18); ST depression > or = 1 mm (n = 122), 80% v 58% (p = 0.014); chi2 = 29, p < 0.001 for the linear trend across the groups. On multivariate analysis, independent predictors of four year mortality were: age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.08; p = 0.0046); ECG group (OR 1.88, 95% CI 1.21 to 2.95; p = 0.043); radiological pulmonary oedema (OR 2.81, 95% CI 1.18 to 7.05; p = 0.025); and revascularisation (OR 0.43, 95% CI 0.20 to 0.90; p = 0.023). CONCLUSIONS: Among unselected patients with non-ST elevation acute coronary syndromes, in-hospital revascularisation is associated with decreased mortality at up to four years after admission. This association appears greater in patients with ST depression of > or = 1 mm on the presenting ECG.
Authors: D A Morrow; C P Cannon; N Rifai; M J Frey; R Vicari; N Lakkis; D H Robertson; D A Hille; P T DeLucca; P M DiBattiste; L A Demopoulos; W S Weintraub; E Braunwald Journal: JAMA Date: 2001-11-21 Impact factor: 56.272
Authors: C P Cannon; W S Weintraub; L A Demopoulos; R Vicari; M J Frey; N Lakkis; F J Neumann; D H Robertson; P T DeLucca; P M DiBattiste; C M Gibson; E Braunwald Journal: N Engl J Med Date: 2001-06-21 Impact factor: 91.245
Authors: V Mathew; M E Farkouh; B J Gersh; C S Rihal; G S Reeder; D E Grill; L H Urban; S L Kopecky; J H Chesebro; D R Holmes Journal: Am Heart J Date: 2001-11 Impact factor: 4.749
Authors: E Diderholm; B Andrén; G Frostfeldt; M Genberg; T Jernberg; B Lagerqvist; B Lindahl; L Wallentin Journal: Eur Heart J Date: 2002-01 Impact factor: 29.983
Authors: R Spacek; P Widimský; Z Straka; E Jiresová; J Dvorák; R Polásek; I Karel; R Jirmár; L Lisa; T Budesínský; F Málek; P Stanka Journal: Eur Heart J Date: 2002-02 Impact factor: 29.983
Authors: L K Michalis; C S Stroumbis; K Pappas; E Sourla; D Niokou; J A Goudevenos; C Siogas; D A Sideris Journal: Eur Heart J Date: 2000-12 Impact factor: 29.983
Authors: Erik Diderholm; Bertil Andrén; Gunnar Frostfeldt; Margareta Genberg; Tomas Jernberg; Bo Lagerqvist; Bertil Lindahl; Per Venge; Lars Wallentin Journal: Am Heart J Date: 2002-05 Impact factor: 4.749
Authors: K A A Fox; P A Poole-Wilson; R A Henderson; T C Clayton; D A Chamberlain; T R D Shaw; D J Wheatley; S J Pocock Journal: Lancet Date: 2002-09-07 Impact factor: 79.321