Continuous 12-lead electrocardiographic ST monitoring adds prognostic information to the thrombolysis in myocardial infarction risk score in patients with non-ST-elevation acute coronary syndromes.
BACKGROUND
Continuous 12-lead electrocardiographic (ECG) ST monitoring and the Thrombolysis In Myocardial Infarction Risk Score (TIMI-RS), both have been shown to be useful for early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTACS).


OBJECTIVE
Transient ST ischemic events, detected by continuous 12-lead ECG ST monitoring, early in the course of NSTACS, may add prognostic information to the TIMI-RS.


METHODS
In all, 567 consecutive patients with a NSTACS underwent 24-h continuous 12-lead ECG ST monitoring. An ST ischemic event was defined as a transient ST shift in any lead of > or = 0.10 mV compared with the reference ECG, lasting for > or = 1 min.


RESULTS
The incidence of the composite of death, nonfatal myocardial infarction (or reinfarction) and recurrent ischemia by Day 14 was 22.2%. By Day 30, the incidence of the composite of death and nonfatal myocardial infarction (or reinfarction) was 14.7%. There was a significantly increased risk of 14-day (p value for trend < 0.001) or 30-day (p value for trend <0.001) composite endpoint with increasing of TIMI-RS. Moreover, the occurrence of > or = 1 ST shifts during ST monitoring was associated with a significantly increased risk of 14- (p value < 0.001) or 30-day (p value < 0.001) composite endpoint, and this was true throughout the groups of TIMI-RS.


CONCLUSIONS
The present study suggests that continuous 12-lead ECG ST monitoring, early in the course of NSTACS, may serve as an affordable tool to add prognostic information to the TIMI-RS.
Zairis
Michael N
MN
Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
Lyras
Anastassios G
AG
Makrygiannis
Stamatis S
SS
Beldekos
Demetrios J
DJ
Mainas
Konstantinos A
KA
Patsourakos
Nikolaos G
NG
Ampartzidou
Olga S
OS
Adamopoulou
Evdokia N
EN
Prekates
Athanasios A
AA
Argyrakis
Spyros K
SK
Foussas
Stefanos G
SG
D000368:Aged; D002423:Cause of Death / Q000639:trends; D015716:Electrocardiography, Ambulatory / Q000187:drug effects / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D019370:Observation; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention; D015996:Survival Rate; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents