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J Am Coll Cardiol, 2001; 38:64-71 © 2001 by the American College of Cardiology Foundation |
* University of Alberta, Edmonton, Alberta, Canada
Duke Clinical Research Institute, Durham, North Carolina, USA
St. Michael’s Hospital, Toronto, Ontario, Canada
Cleveland Clinic Foundation, Cleveland, Ohio, USA
|| University Hospital Gasthuisberg, Leuven, Belgium
Manuscript received August 23, 2000; revised manuscript received March 21, 2001, accepted April 2, 2001.
Reprint requests and correspondence: Dr. Paul W. Armstrong, 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6G 2H7
paul.armstrong{at}ualberta.ca
OBJECTIVES
Our objectives were to develop a risk-stratification model addressing the importance of the magnitude and distribution of ST segment depression in predicting long-term outcomes and to validate the model in an analogous patient population.
BACKGROUND
Although patients without ST segment elevation presenting with acute coronary syndromes represent an increasingly frequent population admitted to coronary care units, little attention has been paid to quantifying their ST segment abnormalities.
METHODS
ST segment depression was categorized into three groups: 1) no ST segment depression; 2) 1-mm ST segment depression in two contiguous leads; and 3) ST segment depression 
2 mm in two contiguous leads. A logistic regression model was developed using Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON-A) data to assess the prognostic value of the extent and distribution of ST segment depression in predicting one-year mortality. The model was validated using the non-ST segment elevation population in Global Use of Strategies To Open occluded arteries in acute coronary syndromes (GUSTO-IIb).
RESULTS
ST segment depression was the strongest predictor of one-year mortality, accounting for 35% of the model’s predictive power. Patients with ST segment depression 2 mm were 
6 times (odds ratio [OR] 5.73, 95% confidence interval [CI] 2.8 to 11.6) more likely to die within one year than patients with no ST segment depression. On validation, the model showed good discriminatory power (c-index = 0.75). Patients with ST segment depression 2 mm in more than one region were almost 10 times more likely to die within one year than patients with no ST segment depression.
CONCLUSIONS
These data provide new evidence supporting the powerful prognostic value of the baseline electrocardiogram and, in particular, the magnitude and distribution of ST segment depression in predicting unfavorable events.
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