Document Detail


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.
MedLine Citation:
PMID:  17604045     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 SigmaST-segment deviation of at least 1 mm. RESULTS: The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 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 SigmaST-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 SigmaST-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.
Authors:
Fons Windhausen; Alexander Hirsch; Jan G P Tijssen; Jan Hein Cornel; Freek W A Verheugt; Margriet I Klees; Robbert J de Winter;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2007-07-02
Journal Detail:
Title:  Journal of electrocardiology     Volume:  40     ISSN:  1532-8430     ISO Abbreviation:  J Electrocardiol     Publication Date:    2007 Sep-Oct
Date Detail:
Created Date:  2007-09-03     Completed Date:  2007-09-24     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-15     Citation Subset:  IM    
Affiliation:
Department of Cardiology of the Academic Medical Center, Amsterdam, The Netherlands. a.windhausen@amc.uva.nl <a.windhausen@amc.uva.nl>
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Angina, Unstable / blood,  diagnosis*,  mortality*,  therapy
Angioplasty, Transluminal, Percutaneous Coronary / mortality
Cardiotonic Agents / therapeutic use
Electrocardiography / statistics & numerical data*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood,  diagnosis*,  mortality*,  therapy
Netherlands
Outcome Assessment (Health Care) / methods
Prevalence
Prognosis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Syndrome
Treatment Outcome
Troponin I / blood
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Troponin I

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