title: Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation.
abstract: BACKGROUND
  Acute coronary syndromes (ACS) without ST elevation are a frequent cause of hospital admission, myocardial infarction and death.
  
  
  OBJECTIVE
  To explore the role of the ECG in stratifying ACS patients.
  
  
  METHODS
  Prospective, centrally-coordinated multicentre registry involving 56 centres throughout the UK.
  
  
  METHODS
  Consecutive patients admitted with ACS without ST elevation on the presenting ECG (n = 1046) were followed for 6 months. A subgroup (n = 653) were flagged with the UK Office for National Statistics and followed-up for death over 4 years.
  
  
  RESULTS
  Mean follow-up for the group as a whole was 2.4 years. In the first 6 months, the death rate was 7.3%. Survival at 1 year was 90.8% (95%CI 88.2%-92.8%); at 45 months it was 77.8% (95%CI 74.1%-81.1%). We compared data in those with ST depression or bundle branch block on the admission ECG (n = 304, 29%) with those with T wave inversion, Q waves and minor ST segment changes (n = 576, 55%) and those with a normal ECG (n = 166, 16%). Their respective incidences of death were 15%, 5% and 2% (p < 0.01) at 6 months, and 38%, 22% and 7% (p < 0.01) at 4 years.
  
  
  CONCLUSIONS
  Rates of adverse events are high in patients admitted to UK hospitals with ACS without ST elevation. The ECG remains a very important and simple discriminator of both short- and long-term risk, enabling more aggressive, proven therapies to be targeted towards those at highest risk.
authors.affiliation: Department of Cardiology, Chelsea & Westminster Hospital, 369 Fulham Road, London. julian.collinson@chelwest.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Collinson
authors.forename: A
authors.initials: A
authors.lastname: Bakhai
authors.forename: A
authors.initials: A
authors.lastname: Taneja
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.forename: M D
authors.initials: MD
authors.lastname: Flather
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000401:mortality*; D002037:Bundle-Branch Block / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000401:mortality*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D006113:United Kingdom