title: Electrocardiographic presentation of global ischemia in acute coronary syndrome predicts poor outcome.
abstract: BACKGROUND
  Global ischemia (GI) electrocardiogram (ECG), wide-spread ST depression with inverted T waves maximally in leads V(4-5), and lead aVR ST elevation (STE), is a marker of an adverse outcome in patients with non-ST elevation acute coronary syndromes (ACS), perhaps because this pattern is indicative of left main stenosis. The prognostic value of this ECG pattern has not been established.
  
  
  OBJECTIVE
  The distribution of ECG changes and the prognostic value of the GI ECG were studied.
  
  
  METHODS
  ECGs of consecutive patients admitted with suspected ACS (n = 1,188) were classified into seven ECG categories: STE, Q waves without STE, left bundle branch block, left ventricular hypertrophy, GI ECG, other ST depression and/or T wave inversion, and other findings.
  
  
  RESULTS
  The GI ECG pattern predicted a high rate (48%) of composite end-points (mortality, re-infarction, unstable angina, resuscitation, or stroke) at 10-month follow-up compared to the other ECG categories (36%) (HR 1.78; CI 95% 1.31-2.41; P < 0.001). In multivariate analysis, the GI ECG pattern was associated with a higher rate of composite end-points (HR 1.40; CI 95% 1.02-1.91; P = 0.035). The multivariate analysis furthermore identified age, creatinine level, and diabetes as independent predictors of prognosis.
  
  
  CONCLUSIONS
  The GI ECG pattern predicted an unfavorable outcome, when compared to other ECG patterns in patients with ACS.
authors.affiliation: Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.
authors.forename: Kjell C
authors.initials: KC
authors.lastname: Nikus
authors.forename: Samuel
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.forename: Pekka
authors.initials: P
authors.lastname: Karhunen
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Eskola
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis