ISCHEMIA DETECTED BY CONTINUOUS ONLINE VECTORCARDIOGRAPHIC MONITORINGPREDICTS UNFAVORABLE OUTCOME IN PATIENTS ADMITTED WITH PROBABLE UNSTABLE CORONARY-DISEASE

Background Several methods have been suggested for risk stratification of patients with unstable coronary syndromes. However, most of these are applied several days after hospital admission. Methods In this stu dy we investigated the prognostic value of continuous ST-segment and Q RS Vector monitoring with computerized vectorcardiography (VCG), seria l measurements of creatine kinase isoenzyme MB (CK-MB), predischarge s tress testing and baseline data in patients with unstable angina pecto ris or non-Q-wave infarction. Results During the 24 h VCG monitoring, 56 (29%) of the 195 patients had ST-vector magnitude (ST-VM) episodes of ischaemia. Seventy-four (38%) patients had a peak CK-MB value of 6 mu g/l or higher during the 48 h sampling period. Several discrete Var iables were associated with death or non-fatal infarction at 1 year of follow-up in an univariate analysis. Among these were age greater tha n or equal to 65 years, female sex, ST depression on the admission ECG or VCG monitoring, and elevated CK-MB levels, but neither the occurre nce, duration nor intensity of chest pain, With Cox's proportional haz ards regression analysis, ST-VM episodes on VCG monitoring were identi fied as independent markers of the risk of death (P = 0.013), death or non-fatal infarction (P = 0.035) and death, non-fatal infarction, uns table angina during the first year, or revascularization before hospit al discharge (P = 0.005). Conclusions VCG monitoring of ischaemia prov ides independent prognostic information in unstable angina. High-risk patients can easily be identified within 24 h of hospital admission. W hether early intervention based on these criteria will result in impro ved prognosis remains to be shown in future studies.