title: Admission wall motion score and quantitative ST-segment depression in the assessment of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  Whether admission myocardial wall motion score (WMS) in non-ST-segment elevation acute coronary syndromes might be a better predictor of 30-day mortality than currently recognized prognostic markers is unknown.
  
  
  METHODS
  Admission echocardiographic and electrocardiographic data as well as coronary angiographic data were prospectively evaluated in 488 patients. Variables analyzed were clinical data, quantitative ST-segment depression, peak troponin I, WMS, ejection fraction, extent of coronary artery disease, and Thrombolysis In Myocardial Infarction (TIMI) risk score.
  
  
  RESULTS
  Severity of WMS in quartiles was associated with peak troponin I (quartile 1, 5.2 μg/L; quartile 2, 9.4 μg/L; quartile 3, 11.7 μg/L; quartile 4, 23.7 μg/L; P < .001) and with the sum of all leads with ST-segment depression (quartile 1, -2.5 mm; quartile 2, -3.2 mm; quartile 3, -3.8 mm; quartile 4, -5.1 mm; P < .001). Thirty-day mortality was associated with increased worsening of WMS (quartiles 1, 0.7%; quartile 2, 3.4%; quartile 3, 3.8%; quartile 4, 11.5%; P = .001) and quantitative ST-segment depression (0 mm, 2.7%; <1.0 mm, 1.8%; 1.0-1.9 mm, 3.5%; 2.0-2.9 mm, 7.3%; ≥3.0 mm, 15.0%; P = .008). Mortality was also associated with age (P = .002), diabetes (P = .007), peripheral vascular disease (P < .001), Killip class ≥ II (P < .001), ejection fraction (P < .001), troponin I level (P < .001), three-vessel and/or left main coronary artery disease (P < .001), and admission TIMI risk score (P < .001). Nevertheless, WMS predicted 30-day mortality after adjusting for TIMI risk score (odds ratio per unit increase, 1.14; 95% confidence interval, 1.06-1.21; P < .001) or for TIMI score and Killip class > I (odds ratio per unit increase, 1.11; 95% confidence interval, 1.04-1.19; P = .004).
  
  
  CONCLUSIONS
  In comparison with quantitative ST-segment depression, troponin I, and TIMI risk score, WMS on admission is a better early predictor of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.
authors.affiliation: Àrea del Cor, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5751jfb@gmail.com
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.forename: José A
authors.initials: JA
authors.lastname: Barrabés
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.forename: Rosa-Maria
authors.initials: RM
authors.lastname: Lidón
authors.forename: Laura
authors.initials: L
authors.lastname: Gutierrez
authors.forename: Bruno
authors.initials: B
authors.lastname: Garcia del Blanco
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality*; D000368:Aged; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: CABG; CI; CK-MB; Confidence interval; Coronary artery bypass grafting; Creatine kinase–MB; ECG; Electrocardiographic; Multivessel disease; NSTEACS; Non–ST-segment elevation acute coronary syndromes; Quantitative ST-segment depression; TIMI; TIMI risk score; Thrombolysis In Myocardial Infarction; TnI; Troponin I; WMS; Wall motion score