title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
authors.forename: Michael N
authors.initials: MN
authors.lastname: Zairis
authors.forename: Anastassios G
authors.initials: AG
authors.lastname: Lyras
authors.forename: Stamatis S
authors.initials: SS
authors.lastname: Makrygiannis
authors.forename: Demetrios J
authors.initials: DJ
authors.lastname: Beldekos
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Mainas
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Patsourakos
authors.forename: Olga S
authors.initials: OS
authors.lastname: Ampartzidou
authors.forename: Evdokia N
authors.initials: EN
authors.lastname: Adamopoulou
authors.forename: Athanasios A
authors.initials: AA
authors.lastname: Prekates
authors.forename: Spyros K
authors.initials: SK
authors.lastname: Argyrakis
authors.forename: Stefanos G
authors.initials: SG
authors.lastname: Foussas
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents