Ta. Hyde et al., Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression, AM J CARD, 84(4), 1999, pp. 379-385
Citations number
23
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
We prospectively evaluated all patients admitted to our coronary care unit
during 1993 with ischemic chest pain but without ST-segment elevation on th
e presenting electrocardiogram, and determined the influence of the extent
of ST-segment depression, measured using calipers and blinded to the outcom
e, on 4-year survival. The presenting symptoms of 367 patients (mean age 64
years) were coded according to the Braunwald classification, 86% being in
class IIIB (primary unstable angina with rest angina within 48 hours) and 7
.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had m
yocardial infarction at presentation (defined as a creatine kinase level ex
ceeding twice the reference range within 18 hours). During hospitalization
97% of patients received aspirin, 67% received intravenous heparin, 37% und
erwent angiography, and 35% underwent revascularization. The vital status o
f 99% of the patients was determined after a median of 52 months (interquar
tile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45
% were taking beta blockers, and 50% had undergone revascularization. The s
urvival rate was 70% in patients with greater than or equal to 0.5-mm ST-se
gment depression (53%, 77%, and 82% survival for greater than or equal to 2
-, 1-, and 0.5-mm ST-segment depression, respectively; p <0.0001). Patients
with a normal electrocardiogram had a greater survival rate (94%) than tha
t of patients with 0.5-mm ST-segment depression (82%, p = 0.020), but not s
ignificantly different from that of patients with T-wave inversion (84%, p
= NS). Independent predictors of mortality (odds ratio [95% confidence inte
rval]) were: age in yearly increments (1.05 [1.03 to 1.06], p 0.003), revas
cularization during follow-up (0.40 [0.29 to 0.56], p = 0.006), pulmonary e
dema (3.45 [2.19 to 5.45], p = 0.007), and ST-segment depression (1.37 [1.2
0 to 1.55], p = 0.015). Thus, ST-segment depression of greater than or equa
l to 0.5 mm predicts 4-year survival in patients with acute ischemic syndro
mes. (C) 1999 by Excerpta Medico, Inc.