Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment.
OBJECTIVE
The aim of the present study was to evaluate whether the effect of an early invasive treatment strategy differed between patients sub-grouped according to their severity of myocardial ischemia, as evaluated by quantitative electrocardiographic (ECG) analysis at the time of presentation. The present study is a sub-study of the previously published Fast Revascularization during InStability in Coronary artery disease trial (FRISC-II).


BACKGROUND
An early invasive treatment strategy has been shown to be the preferable treatment for non-ST-segment elevation acute coronary syndromes (ACS). The population of patients with unstable coronary artery disease is heterogeneous regarding both the underlying pathology and prognosis. Early risk stratification is important to select patient subgroups that will benefit the most from a given treatment.


METHODS
In 2,201 patients with non-ST-segment elevation ACS, the ischemic burden at hospital admission was determined by quantitative measurements of ST-T-segment deviations on the ECG. The patients were subsequently sub-grouped in tertiles based on the amount of ST-segment deviation. The primary end point for this analysis was death or myocardial infarction (MI) within one year after study inclusion.


RESULTS
The invasive treatment strategy produced a reduction of approximately 50% in death or MI among the patients with intermediate or major ST-segment deviation. The findings were independent of age, gender, or troponin T status. The patients with confounding factors precluding ST analysis had a poor outcome regardless of the treatment strategy.


CONCLUSIONS
Ischemic burden on the admission ECG identifies patients with ACS who benefit the most from an invasive treatment strategy. When the standard ECG is scrutinized with complete quantitative measurements, it provides independent information on prognosis and benefit of treatment.
Holmvang
Lene
L
The Heart Center 2141, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. lene.holvang@dadlnet.dk
Clemmensen
Peter
P
Lindahl
Bertil
B
Lagerqvist
Bo
B
Venge
Per
P
Wagner
Galen
G
Wallentin
Lars
L
Grande
Peer
P
D000368:Aged; D000789:Angina, Unstable / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D003955:Diagnostic Tests, Routine; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors