Prognostic value of continuous ST-segment monitoring in patients with non-ST-segment elevation acute coronary
Carlos Aguiar1, Jorge Ferreira, Ricardo Seabra-Gomes
1Department of Cardiology, Santa Cruz Hospital, Carnaxide, Portugal. ctaguiar@hotmail.com
Insights
Continuous ST-segment monitoring offers early prognostic insights for acute coronary syndromes. This method, combined with troponin I levels, helps identify patients at high risk for adverse outcomes.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Medical Monitoring
Background:
- Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) present a heterogeneous patient prognosis.
- Resting ECGs are standard for risk stratification but don't capture dynamic ischemia.
- Continuous ST-segment monitoring's prognostic value in NSTE-ACS requires investigation.
Purpose of the Study:
- To assess the early prognostic utility of continuous ST-segment monitoring in NSTE-ACS patients.
- To determine if ST episodes provide incremental prognostic information beyond troponin levels.
Main Methods:
- Prospective study of 183 NSTE-ACS patients.
- 24-hour continuous ST-segment monitoring from admission.
- Serial cardiac-specific troponin I measurements over 24 hours.
- 30-day follow-up for death or myocardial infarction.
Main Results:
- ST episodes detected in 27.3% of patients, associated with significantly worse 30-day outcomes (22.0% vs. 6.8%).
- ST episodes (HR 3.07) and peak troponin I > 0.2 microg/L (HR 2.65) were independent predictors of prognosis.
- Combined monitoring identified low (2.5%), intermediate (14.5%), and high (25.0%) risk groups.
Conclusions:
- Continuous ST-segment monitoring provides valuable on-line early prognostic information in NSTE-ACS.
- This monitoring adds prognostic value to standard troponin I measurements.
- It enables refined risk stratification for NSTE-ACS patients.
Background:
Patients with non-ST-segment elevation acute coronary syndromes constitute a heterogeneous group concerning prognosis. The 12-lead ECG at rest is recommended for early risk stratification but is unable to reflect the dynamic nature of myocardial ischemia and coronary thrombosis. This study investigated whether continuous ST-segment monitoring provides early prognostic information in such patients.
Methods:
We prospectively studied 183 patients admitted due to chest pain at rest suggestive of an acute coronary syndrome. ST-segment monitoring was performed continuously for 24 hours from admission. Cardiac-specific troponin I levels were determined on admission and every 6 hours for the first 24 hours. The endpoint was defined as death or nonfatal myocardial infarction, whichever occurred first by 30 days follow-up.
Results:
ST episodes, defined as transient ST deviations of at least 0.1 mV, were detected in 50 patients (27.3%) and associated with worse 30-day outcome: 22.0% endpoint rate compared to 6.8% for patients without ST episodes (P = 0.003). In a multivariate analysis, the presence of ST episodes (hazard ratio, 3.07; 95% CI, 1.26 to 7.46; P = 0.014) and peak troponin I levels > 0.2 microg/L (hazard ratio, 2.65; 95% CI, 1.01 to 6.95; P = 0.048) were independent predictors of prognosis. The combination of ST-segment monitoring and peak troponin I identified patients at low (2.5%, n = 79), intermediate (14.5%, n = 76), and high (25.0%, n = 28) risk for the 30-day endpoint.
Conclusions:
In patients with non-ST-segment elevation acute coronary syndromes, continuous ST-segment monitoring provides on-line early prognostic information, in addition to troponin I levels.
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