ST-segment depression in non–ST elevation acute coronary syndromes: Quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification - 17/08/11
for the Canadian ACS Registry Investigators
Résumé |
Background |
It is unclear whether quantitative ST-segment assessment can improve risk stratification of unselected acute coronary syndrome (ACS) patients using the validated Global Registry of Acute Cardiac Events (GRACE) risk model.
Methods |
In the prospective, multicenter, Canadian ACS Registry, the admission electrocardiogram was evaluated centrally at a blinded core laboratory. Patients with ST-elevation myocardial infarction and other electrocardiogram confounders were excluded. ST depression (ST↓) was measured and summed in all leads except aVR. Patients with ST↓ were divided into 3 groups based on tertiles of cumulative ST↓. A multivariable model was developed to examine the independent prognostic value of ST↓ severity after adjusting for other known prognosticators in the GRACE risk model.
Results |
Among 2590 patients with non–ST-elevation ACS, more severe ST↓ was associated with advanced age, higher heart rate and Killip class, elevated creatinine, abnormal biomarkers, higher GRACE risk score, and higher 1-year mortality (all P < .001). After adjusting for these confounding prognosticators, the presence of any ST↓ remained independently associated with higher 1-year mortality (odds ratio 1.78, 95% CI 1.21-2.63, P = .004). However, the gradient of risk with increasing magnitude of ST↓ was no longer evident (adjusted odds ratios 1.77, 1.77, 1.81, for ascending tertiles of cumulative ST↓, respectively). Moreover, quantitative ST↓ did not improve the model discrimination for 1-year mortality. The results were similar when the number of leads with ST↓ or the maximum magnitude of ST↓ was analyzed, after adjusting for tertiles of GRACE risk score or inhospital revascularization, or using the composite end point of death or myocardial (re)infarction at 1 year.
Conclusions |
Greater ST↓ is associated with other adverse prognosticators across the broad spectrum of non–ST-elevation ACS. Although the presence of any ST↓ is an independent predictor of 1-year mortality, its quantitative assessment is not as important as its mere presence when studied on the background of comprehensive clinical and biomarker evaluation in a nonclinical trial–based ACS population.
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Vol 152 - N° 2
P. 270-276 - août 2006 Retour au numéro
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