CLINICAL STUDIES
ST-segment monitoring with continuous 12-lead ECG improves early risk stratification in patients with chest pain and ECG nondiagnostic of acute myocardial infarction
Tomas Jernberg, MDa,
Bertil Lindahl, MD, PhDa and
Lars Wallentin, MD, PhDa
a Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden
Manuscript received January 5, 1999;
revised manuscript received June 8, 1999,
accepted June 30, 1999.
Reprint requests and correspondence: Tomas Jernberg, Department of Cardiology, Cardiothoracic Center, University Hospital, 751 85 Uppsala, Sweden
tomas.jernberg{at}medicin.uu.se
OBJECTIVES
The purpose of this study was to evaluate the prognostic importance of ischemic episodes detected by ST-segment monitoring with continuous 12-lead electrocardiography (ECG) in a nonselected coronary care unit (CCU) population with chest pain and ECG nondiagnostic of acute myocardial infarction (AMI).
BACKGROUND
Patients with chest pain and ECG nondiagnostic of AMI constitute a heterogeneous group concerning both diagnosis and prognosis. Continuous 12-lead ECG is a rather new method not thoroughly studied in this population.
METHODS
The ST-segment monitoring with continuous 12-lead ECG was performed for 12 h in 630 consecutive patients admitted to CCU due to chest pain and a nondiagnostic ECG, i.e., no ST-segment elevations. An ST-episode was defined as a transient ST-segment depression or elevation of at least 0.10 mV. The median follow-up time was six months.
RESULTS
A total of 176 ST-episodes occurred in 100 (15.9%) patients. The median duration and maximal ST-segment deviation in patients with ST-episodes were 80 min and 0.20 mV, respectively. Presence of ST-episodes predicted worse outcome concerning cardiac death and cardiac death or myocardial infarction (MI) (log-rank p < 0.001). At 30 day follow-up procedure, 10% versus 1.5% died from cardiac causes or had an MI in the group with and without ST-episodes, respectively. In a multivariate analysis, only troponin T  0.10 µg/l and the presence of ST-episodes came out as independent predictors of cardiac death or MI.
CONCLUSIONS
Continuous 12-lead ECG monitoring provides prognostic information on-line and considerably improves early risk stratification in patients with ECG nondiagnostic of AMI and symptoms suggestive of acute coronary syndrome.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CCU | = coronary care unit | | CK-MB | = creatine kinase isoenzyme | | ECG | = electrocardiography | | LBBB | = left bundle branch block | | MI | = myocardial infarction | | UCAD | = unstable coronary artery disease | | VCG | = vectorcardiography |
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