Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation


Collinson, J; Bakhai, A; Taneja, A; Wang, D; Flather, MD; (2006) Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation. QJM, 99 (9). pp. 601-607. ISSN 1460-2725 DOI: https://doi.org/10.1093/qjmed/hcl079

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Abstract

Background: Acute coronary syndromes (ACS) without ST elevation are a frequent cause of hospital admission, myocardial infarction and death. Aim: To explore the role of the ECG in stratifying ACS patients. Design: Prospective, centrally-coordinated multicentre registry involving 56 centres throughout the U K. Methods: Consecutive patients admitted with ACS without ST elevation on the presenting ECG (n = 1046) were followed for 6 months. A subgroup (n = 653) were flagged with the UK Office for National Statistics and followed-up for death over 4 years. Results: Mean follow-up for the group as a whole was 2.4 years. In the first 6 months, the death rate was 7.3%. Survival at 1 year was 90.8% (95%CI 88.2%-92.8%); at 45 months it was 77.8% (95%CI 74.1%-81.1%). We compared data in those with ST depression or bundle branch block on the admission ECG (n = 304, 29%) with those with T wave inversion, Q waves and minor ST segment changes (n = 576, 55%) and those with a normal ECG (n = 166, 16%). Their respective incidences of death were 15%, 5% and 2% (p < 0.01) at 6 months, and 38%, 22% and 7% (p < 0.01) at 4 years. Discussion: Rates of adverse events are high in patients admitted to UK hospitals with ACS without ST elevation. The ECG remains a very important and simple discriminator of both short- and long-term risk, enabling more aggressive, proven therapies to be targeted towards those at highest risk.

Item Type: Article
Keywords: GLYCOPROTEIN IIB/IIIA INHIBITORS, EARLY INVASIVE MANAGEMENT, ACUTE, ISCHEMIC SYNDROMES, SEGMENT-ELEVATION, MYOCARDIAL-INFARCTION, UNSTABLE, ANGINA, RISK STRATIFICATION, PROSPECTIVE REGISTRY, GLOBAL REGISTRY, EVENTS GRACE, Aged, Angina, Unstable, mortality, Bundle-Branch Block, epidemiology, Electrocardiography, Female, Great Britain, Humans, Male, Microvascular Angina, mortality, Middle Aged, Myocardial Infarction, mortality, Prognosis, Prospective Studies, Risk Factors, Survival Rate
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 16877473
Web of Science ID: 240428000004
URI: http://researchonline.lshtm.ac.uk/id/eprint/6361

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