Admission standard electrocardiogram for early risk stratification in patients with unstable coronary artery disease not eligible for acute revascularization therapy: a TRIM substudy. ThRombin Inhibition in Myocardial Infarction.
OBJECTIVE
The purpose of this study was to determine the prognostic capacity of a single electrocardiogram (ECG) obtained early after admission to the hospital in patients suspected of non-Q-wave myocardial infarction and unstable angina pectoris.


METHODS
Six hundred twenty-nine patients from the TRIM study were included. The patients were divided into subgroups on the basis of ST-segment changes in the inclusion ECG. Death, acute myocardial infarction, or refractory angina (despite treatment) were registered during a follow-up period of 30 days.


RESULTS
Patients with ST depression had a significantly higher event rate compared with patients with other ECG changes or with normal ECG results. The difference in event rates between patients with ST depression and patients without ST depression regarding the composite of death and acute myocardial infarction was highly significant (P =.0008). A significant association between the magnitude of the ST-segment depression (in millimeters) and the risk of cardiac events was also demonstrated. Multivariate analysis proved ST depression early after admission to be an independent predictor of high risk.


CONCLUSIONS
In patients with unstable coronary artery disease, ST-segment depression at admission is a strong predictor of early (30 days) cardiac events and the extent of ST depression carries important prognostic information as well.
Holmvang
L
L
Heart Center, Rigshospitalet, Copenhagen, Denmark.
Clemmensen
P
P
Wagner
G
G
Grande
P
P
D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003663:Decision Trees; D003955:Diagnostic Tests, Routine / Q000592:standards*; D018572:Disease-Free Survival; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy; D014218:Triage