Document Detail

ST-depression with negative T waves in leads V4-V5--a marker of severe coronary artery disease in non-ST elevation acute coronary syndrome: a prospective study of Angina at rest, with troponin, clinical, electrocardiographic, and angiographic correlation.
MedLine Citation:
PMID:  15245335     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The significance of ST-segment depression in acute coronary syndrome has been the subject of debate for many decades. Studies indicate that different manifestations of ST/T changes may have significantly different prognostic implications. METHODS AND RESULTS: We studied the correlation of ST/T changes in 12-lead electrocardiography recorded during pain, to clinical and angiographic findings and in-hospital prognosis, in patients with non-ST-elevation acute coronary syndrome and elevated troponin levels. Fifty consecutive patients could be differentiated into two groups: (1) 25 patients with ST-segment depression and a negative T wave maximally in leads V4-5, (2) 25 patients with ST-segment depression and a positive T wave in the precordial lead with maximal ST-segment depression. Patients in group I had significantly more often left main or left main equivalent coronary artery disease; 76% versus 8% (P < 0.001), heart failure; 40% versus 4% (P = 0.005), and higher in-hospital mortality; 24% versus 0% (P = 0.02), than patients in group II. The troponin levels did not differ significantly between the groups. CONCLUSIONS: In patients with non-ST-elevation acute coronary syndrome and elevated troponin levels two subgroups could be identified. Transient ST-segment depression and a negative T wave maximally in leads V4-5 during anginal pain predicts left main, left main equivalent, or severe three-vessel coronary artery disease with high sensitivity and specificity. In patients with ST-segment depression and a positive T wave, there is a high probability of one-vessel disease.
Kjell C Nikus; Markku J Eskola; Vesa K Virtanen; Saila Vikman; Kari O Niemelä; Heini Huhtala; Samuel Sclarovsky
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  9     ISSN:  1082-720X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-12     Completed Date:  2004-10-21     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  207-14     Citation Subset:  IM    
Division of Cardiology, Tampere University Hospital, Finland.
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MeSH Terms
Chi-Square Distribution
Coronary Angiography
Coronary Disease / diagnosis*,  physiopathology
Hospital Mortality
Prospective Studies
Statistics, Nonparametric
Troponin / blood
Reg. No./Substance:

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