K. Andersen et al., ISCHEMIA DETECTED BY CONTINUOUS ONLINE VECTORCARDIOGRAPHIC MONITORINGPREDICTS UNFAVORABLE OUTCOME IN PATIENTS ADMITTED WITH PROBABLE UNSTABLE CORONARY-DISEASE, Coronary artery disease, 7(10), 1996, pp. 753-760
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.