[The importance of a normal ECG in non-ST elevation acute coronary syndromes].
BACKGROUND
Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS).


OBJECTIVE
To assess the impact of the admission ECG on prognosis over non-ST ACS.


METHODS
prospective, continuous, observational study of 802 non-ST ACS patients from a single center.


METHODS
Patients were divided in 2 groups: A (n=538) - Abnormal ECG and B (n=264) - Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate.


RESULTS
Group A patients were older (68.7+/-11.7 vs. 63.4+/-12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01+/-10.55 vs. 55.34+/- 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 - 0.97). There were no differences regarding the MACE rate.


CONCLUSIONS
In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.
Teixeira
Rogério
R
Cardiology Department, University Hospitals and Medical School, Coimbra, Portugal. rogeriopteixeira@gmail.com
Lourenço
Carolina
C
António
Natália
N
Monteiro
Sílvia
S
Baptista
Rui
R
Jorge
Elisabete
E
Ferreira
Maria João
MJ
Monteiro
Pedro
P
Freitas
Mário
M
Providência
Luís A
LA
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D004562:Electrocardiography / Q000592:standards*; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis