ST segment shift in unstable angina: pathophysiology and association with coronary anatomy and hospital outcome

Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.

The significance of ST segment shift with respect to coronary anatomy and hospital outcome was evaluated in 135 patients with unstable angina. ST shift was evident in 44% of patients on admission electrocardiogram (ECG) and in 66% on Holter monitor ECG. During hospitalization, 7% of patients had myocardial infarction, 4% died and 34% had urgent coronary revascularization. By comparing patients with and without ST shift on admission ECG, an unfavorable outcome was found in 55% versus 25% (p less than 0.005), multivessel disease in 77% versus 63% (p less than 0.05) and left main coronary artery stenosis in 22% versus 7% (p less than 0.025). When patients with and without ST shift on Holter monitor ECG were compared, an unfavorable outcome was found in 48% versus 20% (p less than 0.005), multivessel disease in 76% versus 54% (p less than 0.01) and left main coronary stenosis in 18% versus 4% (p less than 0.05). The duration of ST shift was also greater in patients with 1) unfavorable outcome (129 +/- 136 versus 52 +/- 111 min, p less than 0.01); 2) multivessel disease (98 +/- 129 versus 36 +/- 90 min, p less than 0.01); and 3) left main stenosis (150 +/- 147 versus 67 +/- 114 min, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				D. Tzivoni and M. W. Krucoff Continuous ST-Segment Monitoring in Contemporary Acute Coronary Syndrome Patients: The Magic of MERLIN-TIMI 36 J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1422 - 1424. [Full Text] [PDF]

				J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]

				S. Savonitto, M. G. Cohen, A. Politi, M. P. Hudson, D. F. Kong, Y. Huang, K. S. Pieper, F. Mauri, G. S. Wagner, R. M. Califf, et al. Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes Eur. Heart J., October 2, 2005; 26(20): 2106 - 2113. [Abstract] [Full Text] [PDF]

				B. J. Drew, R. M. Califf, M. Funk, E. S. Kaufman, M. W. Krucoff, M. M. Laks, P. W. Macfarlane, C. Sommargren, S. Swiryn, and G. F. Van Hare Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses Circulation, October 26, 2004; 110(17): 2721 - 2746. [Abstract] [Full Text] [PDF]

				B L Norgaard, K Andersen, K Thygesen, J Ravkilde, P Abrahamsson, L Grip, and M Dellborg Long term risk stratification of patients with acute coronary syndromes: characteristics of troponin T testing and continuous ST segment monitoring Heart, July 1, 2004; 90(7): 739 - 744. [Abstract] [Full Text] [PDF]

				P. F. Cohn, K. M. Fox, and C. Daly Silent Myocardial Ischemia Circulation, September 9, 2003; 108(10): 1263 - 1277. [Full Text] [PDF]

				A. Hersi, Y. Fu, B. Wong, K.W. Mahaffey, R.A. Harrington, R.M. Califf, F. Van de Werf, P.W. Armstrong, and for the PARAGON-B Investigators Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission? Eur. Heart J., March 2, 2003; 24(6): 522 - 531. [Abstract] [Full Text] [PDF]

				S. G. Goodman, D. Fitchett, P. W. Armstrong, M. Tan, A. Langer, and for the Integrilin and Enoxaparin Randomized Asses Randomized Evaluation of the Safety and Efficacy of Enoxaparin Versus Unfractionated Heparin in High-Risk Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Receiving the Glycoprotein IIb/IIIa Inhibitor Eptifibatide Circulation, January 21, 2003; 107(2): 238 - 244. [Abstract] [Full Text] [PDF]

				M. G. Adams-Hamoda, M. A. Caldwell, N. A. Stotts, and B. J. Drew Factors to Consider When Analyzing 12-Lead Electrocardiograms for Evidence of Acute Myocardial Ischemia Am. J. Crit. Care., January 1, 2003; 12(1): 9 - 16. [Abstract] [Full Text] [PDF]

				M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]

				T. Jernberg, P. Abrahamsson, B. Lindahl, P. Johanson, L. Wallentin, and M. Dellborg Continuous multilead ST-monitoring identifies patients with unstable coronary artery disease who benefit from extended antithrombotic treatment Eur. Heart J., July 2, 2002; 23(14): 1093 - 1101. [Abstract] [Full Text] [PDF]

				M. M. Pelter, M. G. Adams, and B. J. Drew Association of Transient Myocardial Ischemia With Adverse In-Hospital Outcomes for Angina Patients Treated in a Telemetry Unit or a Coronary Care Unit Am. J. Crit. Care., July 1, 2002; 11(4): 318 - 325. [Abstract] [Full Text] [PDF]

				T. Jernberg, B. Lindahl, and L. Wallentin Continuous multilead ST-segment monitoring should be a part of the clinical routine Eur. Heart J., June 2, 2002; 23(12): 918 - 921. [Full Text] [PDF]

				B.J. Drew, M.M. Pelter, and M.G. Adams Frequency, characteristics, and clinical significance of transient ST segment elevation in patients with acute coronary syndromes Eur. Heart J., June 2, 2002; 23(12): 941 - 947. [Abstract] [Full Text] [PDF]

				D.J Patel, A.H Gomma, C.J Knight, D.A Mulcahy, C.A Wright, H.J Purcell, and K.M Fox Why is recurrent myocardial ischaemia a predictor of adverse outcome in unstable angina?. An observational study of myocardial ischaemia and its relation to coronary anatomy Eur. Heart J., November 1, 2001; 22(21): 1991 - 1996. [Abstract] [PDF]

				P. Bogaty, S. Dumont, G. E. O'Hara, L. Boyer, L. Auclair, J. Jobin, and J.-R. Boudreault Randomized trial of a noninvasive strategy to reduce hospital stay for patients with low-risk myocardial infarction J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1289 - 1296. [Abstract] [Full Text] [PDF]

				J. Figueras, Y. Monasterio, R. M. Lidon, E. Nieto, and J. Soler-Soler Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2036 - 2043. [Abstract] [Full Text] [PDF]

				S. G. Goodman, A. Barr, A. Sobtchouk, M. Cohen, G. J. Fromell, L. Laperriere, C. Hill, A. Langer, and for the Canadian Efficacy and Safety of Subcutaneo Low molecular weight heparin decreases rebound ischemia in unstable angina or non-Q-wave myocardial infarction: the Canadian ESSENCE ST segment monitoring substudy J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1507 - 1513. [Abstract] [Full Text] [PDF]

				E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]

				M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology Eur. Heart J., September 1, 2000; 21(17): 1406 - 1432. [PDF]

				T Jernberg, B Lindahl, and L Wallentin The combination of a continuous 12-lead ECG and troponin T. A valuable tool for risk stratification during the first 6 hours in patients with chest pain and a non-diagnostic ECG Eur. Heart J., September 1, 2000; 21(17): 1464 - 1472. [Abstract] [PDF]

				T. Jernberg, B. Lindahl, and L. Wallentin ST-segment monitoring with continuous 12-lead ECG improves early risk stratification in patients with chest pain and ECG nondiagnostic of acute myocardial infarction J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1413 - 1419. [Abstract] [Full Text] [PDF]

				P. W. Armstrong Pursuing Progress in Acute Coronary Syndromes Circulation, October 12, 1999; 100(15): 1586 - 1589. [Full Text] [PDF]

				B. L. Norgaard, K. Andersen, M. Dellborg, P. Abrahamsson, J. Ravkilde, K. Thygesen, and for the TRIM study group Admission risk assessment by cardiac troponin T in unstable coronary artery disease: additional prognostic information from continuous ST segment monitoring J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1519 - 1527. [Abstract] [Full Text] [PDF]

				S. M. Zaacks, P. R. Liebson, J. E. Calvin, J. E. Parrillo, and L. W. Klein Unstable angina and non-Q wave myocardial infarction: does the clinical diagnosis have therapeutic implications? J. Am. Coll. Cardiol., January 1, 1999; 33(1): 107 - 118. [Abstract] [Full Text] [PDF]

				R. M. Califf Ten Years of Benefit From a One-Hour Intervention Circulation, December 15, 1998; 98(24): 2649 - 2651. [Full Text] [PDF]

				P. W. Armstrong, Y. Fu, W.-C. Chang, E. J. Topol, C. B. Granger, A. Betriu, F. Van de Werf, K. L. Lee, R. M. Califf, and f. t. G.-I. Investigators Acute Coronary Syndromes in the GUSTO-IIb Trial : Prognostic Insights and Impact of Recurrent Ischemia Circulation, November 3, 1998; 98(18): 1860 - 1868. [Abstract] [Full Text] [PDF]

				P. Klootwijk, S. Meij, R. Melkert, T. Lenderink, and M. L. Simoons Reduction of Recurrent Ischemia With Abciximab During Continuous ECG-Ischemia Monitoring in Patients With Unstable Angina Refractory to Standard Treatment (CAPTURE) Circulation, October 6, 1998; 98(14): 1358 - 1364. [Abstract] [Full Text] [PDF]

				M. Galvani, F. Ottani, D. Ferrini, J. H. Ladenson, A. Destro, D. Baccos, F. Rusticali, and A. S. Jaffe Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina Circulation, April 15, 1997; 95(8): 2053 - 2059. [Abstract] [Full Text]

				D. J. Patel, C. J. Knight, D. R. Holdright, D. Mulcahy, D. Clarke, C. Wright, H. Purcell, and K. M. Fox Pathophysiology of Transient Myocardial Ischemia in Acute Coronary Syndromes: Characterization by Continuous ST-Segment Monitoring Circulation, March 4, 1997; 95(5): 1185 - 1192. [Abstract] [Full Text]

				J. Figueras and R. M. Lidon Early Morning Reduction in Ischemic Threshold in Patients With Unstable Angina and Significant Coronary Disease Circulation, October 1, 1995; 92(7): 1737 - 1742. [Abstract] [Full Text]

				A. Salahas, A. Kranidis, K. Kostopoulos, I. Antonelis, and M. Kolettis Correlation of Clinical and Electrocardiographic Variables with Coronary Lesions in Unstable Angina Pectoris Angiology, September 1, 1995; 46(9): 827 - 832. [Abstract] [PDF]

				F. Ottani, M. Galvani, D. Ferrini, F. Sorbello, P. Limonetti, D. Pantoli, and F. Rusticali Prodromal Angina Limits Infarct Size : A Role for Ischemic Preconditioning Circulation, January 15, 1995; 91(2): 291 - 297. [Abstract] [Full Text]

				G. Liuzzo, L. M. Biasucci, J. R. Gallimore, R. L. Grillo, A. G. Rebuzzi, M. B. Pepys, and A. Maseri The Prognostic Value of C-Reactive Protein and Serum Amyloid A Protein in Severe Unstable Angina N. Engl. J. Med., August 18, 1994; 331(7): 417 - 424. [Abstract] [Full Text]

				A. J. Moss, R. E. Goldstein, W. J. Hall, J. T. Bigger Jr, J. L. Fleiss, H. Greenberg, M. Bodenheimer, R. J. Krone, F. I. Marcus, F. J. Th. Wackers, et al. Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event JAMA, May 12, 1993; 269(18): 2379 - 2385. [Abstract] [PDF]

				J. D. Marmur, M. R. Freeman, A. Langer, and P. W. Armstrong Prognosis in Medically Stabilized Unstable Angina: Early Holter ST-Segment Monitoring Compared with Predischarge Exercise Thallium Tomography Ann Intern Med, October 15, 1990; 113(8): 575 - 579. [Abstract] [PDF]

				ST-SEGMENT SHIFT A WARNING SIGN IN UNSTABLE ANGINA Journal Watch (General), June 16, 1989; 1989(616): 4 - 4. [Full Text]