TY - JOUR
T1 - 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
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.
PY - 2007
Y1 - 2007
N2 - Background: We assessed the prognostic significance of the presence of cumulative (Sigma) 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 Sigma ST-segment deviation of at least 1 mm. Results: The incidence of death or myocardial infarction (MI) by 1 year in patients with Sigma ST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with Sigma ST-segment deviation of less than 1 mm (P =.001). Among patients with E ST-segment deviation of at least I 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 Sigma 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 Sigma 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. (c) 2007 Elsevier Inc. All rights reserved
AB - Background: We assessed the prognostic significance of the presence of cumulative (Sigma) 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 Sigma ST-segment deviation of at least 1 mm. Results: The incidence of death or myocardial infarction (MI) by 1 year in patients with Sigma ST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with Sigma ST-segment deviation of less than 1 mm (P =.001). Among patients with E ST-segment deviation of at least I 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 Sigma 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 Sigma 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. (c) 2007 Elsevier Inc. All rights reserved
U2 - https://doi.org/10.1016/j.jelectrocard.2007.05.008
DO - https://doi.org/10.1016/j.jelectrocard.2007.05.008
M3 - Article
C2 - 17604045
SN - 0022-0736
VL - 40
SP - 408
EP - 415
JO - Journal of electrocardiology
JF - Journal of electrocardiology
IS - 5
ER -