Prognostic value of the admission electrocardiogram in patients with unstable angina/non–ST-segment elevation myocardial infarction treated with very early revascularization

• Published in: The American journal of medicine Vol. 117; no. 3; pp. 145 - 150
• Main Authors: Mueller, Christian, Neumann, Franz-Josef, Perach, Wolfgang, Perruchoud, André P, Buettner, Heinz J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2004; Elsevier
• Subjects: Aged; Angina, Unstable - diagnosis; Angina, Unstable - mortality; Angina, Unstable - surgery; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Coronary Angiography; Coronary heart disease; Diagnostic Tests, Routine; Electrocardiography; Female; General aspects; Heart; Humans; Male; Medical sciences; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization; Myocarditis. Cardiomyopathies; Prognosis; Prospective Studies; Treatment Outcome; Human; Myocardial infarction; Cardiovascular disease; Coronary heart disease; Myocardial disease; Medicine; ST elevation; Electrodiagnosis; Treatment; Electrocardiography; Predictive value; Early; Variant angina; Revascularization
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2004.02.034

The goals of this study were to determine if very early revascularization might ameliorate the adverse prognosis associated with ST-segment depression in patients with unstable angina/non–ST-segment elevation myocardial infarction. In this prospective cohort study, 1450 consecutive patients with unstable angina/non–ST-segment elevation myocardial infarction were stratified by the presence of ST-segment depression, T-wave inversion, or no changes on the admission electrocardiogram (ECG). All patients underwent coronary angiography and, if appropriate, revascularization within 24 hours after admission. The primary endpoint was all-cause mortality. During up to 59 months of follow-up, the in-hospital mortality rate was 2.1% (19/895) in patients with no ECG changes, 4% (6/136) in those with ST-segment depression, and 0.2% (1/419) in those with T-wave inversion. The cumulative death rate at 36 months was 8.0% (n = 49) in patients with no ECG changes, 19.9% (n = 18) in patients with ST-segment depression, and 5.1% (n = 13) in patients with T-wave inversion ( P = 0.0001 by log-rank). After adjustment for potential cofounders, ST-segment depression (hazard ratio [HR] = 2.2; 95% confidence interval [CI]: 1.1 to 4.6) and T-wave inversion (HR = 0.44; 95% CI: 0.20 to 0.96) were associated with long-term mortality. ST-segment depression and T-wave inversion on the admission ECG were important predictors of outcome in patients with unstable angina/non–ST-segment elevation myocardial infarction undergoing very early revascularization. In contrast to the considerable mortality seen in patients with ST-segment depression, T-wave inversion was associated with a more favorable outcome.