Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?

• Published in: European heart journal Vol. 24; no. 6; pp. 522 - 531
• Main Authors: Hersi, A., Fu, Y., Wong, B., Mahaffey, K.W., Harrington, R.A., Califf, R.M., Van de Werf, F., Armstrong, P.W.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2003
• Subjects: Acetates - therapeutic use; Acute Disease; Aged; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - surgery; Biological and medical sciences; Cardiology. Vascular system; Coronary Disease - drug therapy; Coronary Disease - physiopathology; Coronary Disease - surgery; Coronary heart disease; Disease-Free Survival; Electrocardiogram; Electrocardiography; Female; Heart; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Non-Q wave MI; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Survival Analysis; Troponin T - analysis; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use; Unstable angina; Human; Prognosis; Acquired; Unstable angina; Cardiovascular disease; Coronary heart disease; Phlebology; Discharge; ST elevation; Electrodiagnosis; Non-Q wave MI; Electrocardiogram; Electrocardiography; Circulatory system; Q wave; Cardiology; Variant angina
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1016/S0195-668X(02)00525-0

Background Although the prognostic value of admission ST changes in patients with non-ST elevation acute coronary syndrome (ACS) is established, the utility of the discharge ECG is unknown. Accordingly, using the PARAGON-B Troponin substudy, we assessed the prevalence of ST depression on both admission and discharge ECG, the likelihood of developing new Q-waves at discharge and the additional prognostic value of these changes. Methods and results Nine hundred and eighteen patients were studied; 542 patients (59%) had admission ST↓ ≥1mm and 376 patients (41%) did not and their 6-month mortality was 4.4 vs 0.8%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P=0.002\) \end{document}, respectively. Of patients with ST↓ on admission, 320 (59%) normalized their ST segment at discharge. Of patients without ST↓ on admission, 35 (9.3%) developed new ST↓ at discharge. Patients with persistent ST↓ on discharge had a higher 6-month mortality (6.0 vs 0.9%), (re)MI (16.3 vs 7.4%), and death/(re)MI (20.0 vs 8.3%) than those who never had ST↓ (all \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P{\leq}0.002\) \end{document}). Two hundred and fifty-six patients had Q-waves on admission whereas by discharge 320 had Q-waves. Patients with Q-waves on discharge vs those without had a higher mortality (4.8 vs 1.9%), (re)MI (13.8 vs 8.3%), and death/(re)MI (16.4 vs 9.6%) at 6 months (all \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P{\leq}0.021\) \end{document}). Conclusions This study highlights that the dynamic ECG changes which occur between admission and discharge in non-ST elevation ACS patients allows further risk stratification in determining the likelihood of 6-month death and/or re(MI).