Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?
BACKGROUND
Although the prognostic value of admission ST changes in patients with non-ST elevation acute coronary syndrome (ACS) is established, the utility of the discharge ECG is unknown. Accordingly, using the PARAGON-B Troponin substudy, we assessed the prevalence of ST depression on both admission and discharge ECG, the likelihood of developing new Q-waves at discharge and the additional prognostic value of these changes.


RESULTS
Nine hundred and eighteen patients were studied; 542 patients (59%) had admission ST downward arrow > or =1mm and 376 patients (41%) did not and their 6-month mortality was 4.4 vs 0.8%, P=0.002, respectively. Of patients with ST downward arrow on admission, 320 (59%) normalized their ST segment at discharge. Of patients without ST downward arrow on admission, 35 (9.3%) developed new ST downward arrow at discharge. Patients with persistent ST downward arrow on discharge had a higher 6-month mortality (6.0 vs 0.9%), (re)MI (16.3 vs 7.4%), and death/(re)MI (20.0 vs 8.3%) than those who never had ST downward arrow (all P< or =0.002). Two hundred and fifty-six patients had Q-waves on admission whereas by discharge 320 had Q-waves. Patients with Q-waves on discharge vs those without had a higher mortality (4.8 vs 1.9%), (re)MI (13.8 vs 8.3%), and death/(re)MI (16.4 vs 9.6%) at 6 months (all P< or =0.021).


CONCLUSIONS
This study highlights that the dynamic ECG changes which occur between admission and discharge in non-ST elevation ACS patients allows further risk stratification in determining the likelihood of 6-month death and/or re(MI).
Hersi
A
A
University of Alberta, 2-51 Medical Science Building, Edmonton, Canada T6G 2H7.
Fu
Y
Y
Wong
B
B
Mahaffey
K W
KW
Harrington
R A
RA
Califf
R M
RM
Van de Werf
F
F
Armstrong
P W
PW
D000085:Acetates / Q000627:therapeutic use; D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D003327:Coronary Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D016019:Survival Analysis; D020107:Troponin T / Q000032:analysis; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000085:Acetates; D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D014443:Tyrosine; C084062:lamifiban