Continuous multilead ST-monitoring identifies patients with unstable coronary artery disease who benefit from
T Jernberg1, P Abrahamsson, B Lindahl
1Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden.
Insights
Multilead ST-monitoring identified patients with unstable coronary artery disease who benefit from extended anticoagulant therapy. Those with ischemic episodes showed reduced cardiac events with prolonged low-molecular weight heparin treatment.
Area of Science:
- Cardiology
- Clinical Trials
- Medical Monitoring
Background:
- Unstable coronary artery disease (CAD) poses a risk for cardiac events.
- Extended anticoagulant therapy may reduce these events.
- Multilead ST-segment monitoring can identify high-risk patients.
Purpose of the Study:
- To evaluate multilead ST-monitoring for identifying patients with unstable CAD who benefit from extended low-molecular weight heparin (LMWH).
- To assess the efficacy of prolonged LMWH treatment in patients identified by ST-monitoring.
Main Methods:
- A substudy of the FRISC II trial involving 629 unstable CAD patients.
- 24-hour continuous 12-lead ECG or vectorcardiography (ST-monitoring).
- Randomization to 3-month dalteparin (LMWH) or placebo after initial treatment.
Main Results:
- Ischemic episodes detected in 34% of patients during ST-monitoring.
- Extended dalteparin significantly reduced death, myocardial infarction, or revascularization in patients with ischemic episodes (35.2% vs 53.4%).
- No significant benefit of extended dalteparin was observed in patients without ischemic episodes.
Conclusions:
- Multilead ST-monitoring effectively identifies unstable CAD patients who benefit from extended anticoagulant therapy.
- Ischemic episodes detected during monitoring are key indicators for treatment response.
- This strategy aids in personalized anticoagulant treatment for unstable CAD.
Aims:
Prolongation of anticoagulant treatment might reduce subsequent cardiac events in patients with unstable coronary artery disease. Multilead ST-segment monitoring identifies patients with a high risk of adverse outcome. The aim was to assess the value of multilead ST-monitoring in prospectively identifying patients who respond to extended anticoagulant treatment with low-molecular weight heparin when treated by a primarily non-invasive strategy.
Methods And Results:
In this substudy of the FRISC II trial, ST-monitoring with a continuous 12-lead ECG or vectorcardiography was performed for 24 h in 629 patients with unstable coronary artery disease randomized to receive either the low-molecular weight heparin dalteparin, or placebo for 3 months after at least 5 days' dalteparin treatment in all patients. Ischaemic episodes were detected in 34% during ST-monitoring. In the group with ischaemic episodes, the extended dalteparin treatment was associated with a lower rate of death, myocardial infarction, or revascularization (35.2% vs 53.4%, relative risk reduction: 34%, P=0.01). In patients without ischaemic episodes, long-term dalteparin treatment had no effect.
Conclusions:
In patients with unstable coronary artery disease treated primarily with a non-invasive strategy, ischaemic episodes revealed while on multilead ST-monitoring identifies patients who benefit most from extended treatment with anticoagulants.
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