CLINICAL STUDY: ACUTE CORONARY SYNDROME/MYOCARDIAL INFARCTION
Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment
Lene Holmvang, MD*,*,
Peter Clemmensen, MD, PhD*,
Bertil Lindahl, MD, PhD ,
Bo Lagerqvist, MD,
Per Venge, MD,
Galen Wagner, MD ,
Lars Wallentin, MD, PhD, FACC and
Peer Grande, MD, PhD*
* Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
Duke Clinical Research Institute, Durham, North Carolina, USA
Manuscript received August 7, 2002;
revised manuscript received October 31, 2002,
accepted November 11, 2002.
* Reprint requests and correspondence: Dr. Lene Holmvang, The Heart Center 2141, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø Denmark.
lene.holmvang{at}dadlnet.dk
OBJECTIVES: The aim of the present study was to evaluate whether the effect of an early invasive treatment strategy differed between patients sub-grouped according to their severity of myocardial ischemia, as evaluated by quantitative electrocardiographic (ECG) analysis at the time of presentation. The present study is a sub-study of the previously published Fast Revascularization during InStability in Coronary artery disease trial (FRISC-II).
BACKGROUND: An early invasive treatment strategy has been shown to be the preferable treatment for non–ST-segment elevation acute coronary syndromes (ACS). The population of patients with unstable coronary artery disease is heterogeneous regarding both the underlying pathology and prognosis. Early risk stratification is important to select patient subgroups that will benefit the most from a given treatment.
METHODS: In 2,201 patients with non–ST-segment elevation ACS, the ischemic burden at hospital admission was determined by quantitative measurements of ST-T-segment deviations on the ECG. The patients were subsequently sub-grouped in tertiles based on the amount of ST-segment deviation. The primary end point for this analysis was death or myocardial infarction (MI) within one year after study inclusion.
RESULTS: The invasive treatment strategy produced a reduction of  50% in death or MI among the patients with intermediate or major ST-segment deviation. The findings were independent of age, gender, or troponin T status. The patients with confounding factors precluding ST analysis had a poor outcome regardless of the treatment strategy.
CONCLUSIONS: Ischemic burden on the admission ECG identifies patients with ACS who benefit the most from an invasive treatment strategy. When the standard ECG is scrutinized with complete quantitative measurements, it provides independent information on prognosis and benefit of treatment.
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Abbreviations and Acronyms
| | ACS | | acute coronary syndrome(s) | | CABG | | coronary artery bypass graft surgery | | CAD | | coronary artery disease | | ECG | | electrocardiogram, electrocardiographic | | FRISC-II | | Fast Revascularization during InStability in Coronary artery disease trial | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | PTCA | | percutaneous transluminal coronary angioplasty | | TnT | | troponin T | | ULN | | upper limit of normal |
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