Document Detail


Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression: a TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38) substudy.
MedLine Citation:
PMID:  20723851     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to determine angiographic and clinical outcomes among patients with acute coronary syndrome (ACS) presenting with isolated anterior ST-segment depression on 12-lead electrocardiogram (ECG).
BACKGROUND: In patients with ACS, anterior ST-segment depression on 12-lead ECG may represent plaque rupture with: 1) acute thrombotic occlusion with elevation of cardiac biomarkers (+Tn); 2) a patent artery with +Tn; or 3) a patent artery with -Tn.
METHODS: The TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis In Myocardial Infarction 38) enrolled 13,608 ACS patients. Those with isolated anterior (leads V(1) to V(4)) ST-segment depression were analyzed. Angiograms and ECGs were interpreted by local investigators.
RESULTS: There were 1,198 (8.8%) patients with isolated anterior ST-segment depression. Of those, 314 (26.2%) had an occluded culprit artery (TIMI flow grade 0/1) and +Tn, 641 (53.5%) had a patent culprit artery (TIMI flow grade 2/3) and +Tn, and 243 (20.3%) had TIMI flow grade 2/3 and -Tn. Among patients with an occluded artery, the culprit artery was most often the left circumflex artery (48.4%). The 30-day incidence of the composite of death and MI was significantly higher among patients with an occluded artery (8.6%) than among those with a patent culprit artery and either +Tn (6.3%) or -Tn (2.9%) (3-way p = 0.006). Among patients with an occluded artery, the median time from ECG to percutaneous coronary intervention was 29.4 h (interquartile range 26.1 to 44.1 h).
CONCLUSIONS: Among ACS patients presenting with isolated anterior ST-segment depression, over one-quarter had an occluded culprit artery and elevated cardiac biomarkers. These patients had significantly worse clinical outcomes, and few underwent urgent angiography.
Authors:
Yuri B Pride; Patricia Tung; Satishkumar Mohanavelu; Cafer Zorkun; Stephen D Wiviott; Elliott M Antman; Robert Giugliano; Eugene Braunwald; C Michael Gibson;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-12-13     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  806-11     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy,  etiology,  mortality,  radiography,  therapy*
Aged
Angina, Unstable / drug therapy,  etiology,  mortality,  radiography,  therapy*
Angioplasty, Balloon, Coronary* / adverse effects,  mortality
Biological Markers / blood
Chi-Square Distribution
Coronary Angiography*
Coronary Stenosis / complications,  drug therapy,  mortality,  radiography,  therapy*
Creatine Kinase, MB Form / blood
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy,  etiology,  mortality,  radiography,  therapy*
Piperazines / therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use*
Proportional Hazards Models
Randomized Controlled Trials as Topic
Retrospective Studies
Risk Assessment
Risk Factors
Thiophenes / therapeutic use*
Time Factors
Treatment Outcome
Up-Regulation
Vascular Patency
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Piperazines; 0/Platelet Aggregation Inhibitors; 0/Thiophenes; 0/prasugrel; EC 2.7.3.2/Creatine Kinase, MB Form

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