In-hospital prognostic relevance of a reduced ischemic threshold. Studies in 357 consecutive patients with acute coronary syndromes.
In 357 patients with unstable coronary syndromes, a reduced pacing ischemic threshold (1-mm ST-segment depression at a heart rate < or = 150 beats per minute) was an independent predictor of main in-hospital events (death, myocardial infarction, or coronary surgery), which occurred in 33 percent (65/200) of the patients with a reduced threshold and in 8 percent (13/157) of those with a normal threshold (p < 0.0001). The incidences of death and infarction in patients with a normal (> 150 beats per minute), modestly reduced (140 to 150 beats per minute), or severely reduced (< or = 130 beats per minute) threshold were progressively higher (1 percent and 4 percent; 3 percent and 12 percent; and 7 percent and 18 percent respectively; p < 0.01). Thus, a reduced coronary reserve is associated with a fourfold increase in in-hospital complications; and when the reserve is severely curtailed, there may be a sevenfold increase in mortality.
Figueras
J
J
Unitat Coronaria, Servei de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain.
Lidón
R M
RM
D000208:Acute Disease; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D016002:Discriminant Analysis; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D016896:Treatment Outcome