Format

Send to

Choose Destination
JAMA. 1999 Feb 24;281(8):707-13.

Prognostic value of the admission electrocardiogram in acute coronary syndromes.

Author information

1
Department of Cardiology A. De Gasperis, Ospedale Niguarda Cá Granda, Milan, Italy. ssavoni@tin.it

Abstract

CONTEXT:

The presence of ischemic changes on electrocardiogram (ECG) correlates with poorer outcomes in patients with acute chest pain.

OBJECTIVE:

To determine the prognostic value of various ECG presentations of acute myocardial ischemia.

DESIGN:

Retrospective analysis of the presenting ECGs of patients enrolled in Global Use of Strategies To Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb).

SETTING:

Three hundred seventy-three hospitals in 13 countries in North America, Europe, Australia, and New Zealand.

PATIENTS:

A total of 12142 patients who reported symptoms of cardiac ischemia at rest within 12 hours of admission and had signs of myocardial ischemia confirmed by ECG. On presenting ECG, 22% of patients had T-wave inversion, 28% had ST-segment elevation, 35% had ST-segment depression, and 15% had a combination of ST-segment elevation and depression.

MAIN OUTCOME MEASURE:

Ability of presenting ECG to predict death or myocardial reinfarction during the first 30 days of follow-up.

RESULTS:

The 30-day incidence of death or myocardial reinfarction was 5.5% in patients with T-wave inversion, 9.4% in those with ST-segment elevation, 10.5% in those with ST-segment depression, and 12.4% in those with ST-segment elevation and depression (P<.001). After adjusting for factors associated with an increased risk of 30-day death or reinfarction, compared with those who had T-wave inversion only, the odds of 30-day death or reinfarction were 1.68 (95% confidence interval [CI], 1.36-2.08) in those with ST-segment elevation, 1.62 (95% CI, 1.32-1.98) for those with ST-segment depression, and 2.27 (95% CI, 1.80-2.86) for those with combined elevation and depression. An elevated creatine kinase level at admission correlated with a higher risk of death (odds ratio [OR], 2.36; 95% CI, 1.92-2.91) and death or reinfarction (OR, 1.56; 95% CI, 1.32-1.85). The ECG category and creatine kinase level at admission remained highly predictive of death and myocardial infarction after multivariate adjustment for the significant baseline predictors of events.

CONCLUSIONS:

The ECG at presentation allows immediate risk stratification across the spectrum of acute coronary syndromes. An elevated creatine kinase level at admission is associated with worse outcomes.

PMID:
10052440
DOI:
10.1001/jama.281.8.707
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center