title: Associations between ST depression, four year mortality, and in-hospital revascularisation in unselected patients with non-ST elevation acute coronary syndromes.
abstract: OBJECTIVE
  To determine the associations between changes on the presenting ECG, in-hospital revascularisation, and four year mortality in patients with non-ST elevation acute coronary syndromes.
  
  
  METHODS
  Prospective evaluation of all consecutive patients admitted in 1993 to the Green Lane Hospital coronary care unit, Auckland, New Zealand. Late follow up was undertaken at a median of 52 months. The ECGs were analysed after the hospital admission.
  
  
  METHODS
  Tertiary referral centre with direct local coronary care unit admissions.
  
  
  METHODS
  Patients underwent physician recommended in-hospital revascularisation or initial conservative management.
  
  
  RESULTS
  The four year survival was 88% in the 115 patients who underwent revascularisation (65 (19%) percutaneous and 53 (16%) surgical revascularisation), compared with 75% in 316 patients managed conservatively (p = 0.024). Four year survival for patients undergoing revascularisation versus initial conservative management with respect to ECG groups was: no ECG changes (n = 101), 97% v 92% (p = 0.35); T wave inversion or 0.5 mm ST depression (n = 108), 89% v 78% (p = 0.18); ST depression > or = 1 mm (n = 122), 80% v 58% (p = 0.014); chi2 = 29, p < 0.001 for the linear trend across the groups. On multivariate analysis, independent predictors of four year mortality were: age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.08; p = 0.0046); ECG group (OR 1.88, 95% CI 1.21 to 2.95; p = 0.043); radiological pulmonary oedema (OR 2.81, 95% CI 1.18 to 7.05; p = 0.025); and revascularisation (OR 0.43, 95% CI 0.20 to 0.90; p = 0.023).
  
  
  CONCLUSIONS
  Among unselected patients with non-ST elevation acute coronary syndromes, in-hospital revascularisation is associated with decreased mortality at up to four years after admission. This association appears greater in patients with ST depression of > or = 1 mm on the presenting ECG.
authors.affiliation: Cardiology Department, Green Lane Hospital, Auckland, New Zealand. tom.hyde@bartsandthelondon.nhs.uk
authors.forename: T A
authors.initials: TA
authors.lastname: Hyde
authors.forename: J K
authors.initials: JK
authors.lastname: French
authors.forename: C-K
authors.initials: CK
authors.lastname: Wong
authors.forename: C
authors.initials: C
authors.lastname: Edwards
authors.forename: R M L
authors.initials: RM
authors.lastname: Whitlock
authors.forename: H D
authors.initials: HD
authors.lastname: White
mesh_terms: D000704:Analysis of Variance; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors