Ischemia Detected on Continuous Electrocardiography After Acute Coronary SyndromeObservations From the MERLIN–TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction 36) Trial
Benjamin M. Scirica, MD, MPH*, ,*,
David A. Morrow, MD, MPH*,,
Andrzej Budaj, MD, PhD ,
Anthony J. Dalby, MD ,
Satishkumar Mohanavelu, MS*,
Jie Qin, MS*,
Julian Aroesty, MD*,
Chester M. Hedgepeth, MD, PhD,
Peter H. Stone, MD and
Eugene Braunwald, MD*,
* TIMI Study Group, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
Milpark Hospital, Johannesburg, South Africa
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Figure 1 Frequency of Ischemic Episodes Detected on cECG
Frequency of ischemic episodes by the day of continuous electrocardiographic (cECG) recording after randomization. The yellow bars represent the total number of ischemic episodes per day. The blue bars represent the number of patients who experienced at least 1 episode of ischemia per day, and the green bars represent the number of patients who experienced their first episode of ischemia per day.
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Figure 2 Ischemia Detected on cECG and Cardiac Outcomes
Cumulative incidence of cardiovascular death (A) and the primary end point of cardiovascular death, myocardial infarction (MI), or recurrent ischemia (B) according to the number of ischemic episodes detected on continuous electrocardiography (cECG). The red lines represent >2 episodes; the blue lines represent 1 to 2 episodes; the green lines represent no episodes. HR = hazard ratio.
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Figure 3 Effect of Ranolazine on Ischemia Detected on cECG
(A) The effect of ranolazine on ischemic episodes that occurred 72 h after randomization. Patients who had events during the first 72 h were included in this analysis. There was no statistical interaction between timing of the event and treatment with ranolazine. (B) The relationship between ischemic episodes and ranolazine according to the heart rate at the onset of ST-segment depression. cECG = continuous electrocardiographic monitoring; HR = hazard ratio.
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