Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation
J Collinson1, A Bakhai, A Taneja
1Department of Cardiology, Chelsea & Westminster Hospital, 369 Fulham Road, London. julian.collinson@chelwest.nhs.uk
Insights
Acute coronary syndromes (ACS) without ST elevation carry high mortality. The electrocardiogram (ECG) effectively identifies high-risk patients, guiding targeted therapies for improved outcomes.
Area of Science:
- Cardiology
- Medical Diagnostics
- Public Health
Background:
- Acute coronary syndromes (ACS) without ST elevation are a significant cause of hospitalizations, myocardial infarction, and mortality.
- Effective risk stratification is crucial for managing these patients.
Purpose of the Study:
- To investigate the prognostic value of the electrocardiogram (ECG) in stratifying patients with ACS.
- To determine the role of ECG findings in predicting short- and long-term adverse events.
Main Methods:
- A prospective, multicentre registry study involving 1046 patients admitted with ACS without ST elevation across 56 UK centers.
- Patients were followed for 6 months, with a subgroup of 653 patients followed for death over 4 years via the UK Office for National Statistics.
Main Results:
- The 6-month mortality rate was 7.3%.
- Significant differences in mortality were observed based on ECG findings: ST depression/bundle branch block (15% at 6 months, 38% at 4 years) versus T wave inversion/Q waves/minor ST changes (5% at 6 months, 22% at 4 years) versus normal ECG (2% at 6 months, 7% at 4 years).
- Overall survival at 1 year was 90.8% and at 45 months was 77.8%.
Conclusions:
- Patients admitted with ACS without ST elevation face high rates of adverse events.
- The ECG is a vital, simple tool for discriminating short- and long-term risk in ACS patients.
- Targeting aggressive therapies towards high-risk individuals identified by ECG can improve outcomes.
Background:
Acute coronary syndromes (ACS) without ST elevation are a frequent cause of hospital admission, myocardial infarction and death.
Aim:
To explore the role of the ECG in stratifying ACS patients.
Design:
Prospective, centrally-coordinated multicentre registry involving 56 centres throughout the UK.
Methods:
Consecutive patients admitted with ACS without ST elevation on the presenting ECG (n = 1046) were followed for 6 months. A subgroup (n = 653) were flagged with the UK Office for National Statistics and followed-up for death over 4 years.
Results:
Mean follow-up for the group as a whole was 2.4 years. In the first 6 months, the death rate was 7.3%. Survival at 1 year was 90.8% (95%CI 88.2%-92.8%); at 45 months it was 77.8% (95%CI 74.1%-81.1%). We compared data in those with ST depression or bundle branch block on the admission ECG (n = 304, 29%) with those with T wave inversion, Q waves and minor ST segment changes (n = 576, 55%) and those with a normal ECG (n = 166, 16%). Their respective incidences of death were 15%, 5% and 2% (p < 0.01) at 6 months, and 38%, 22% and 7% (p < 0.01) at 4 years.
Discussion:
Rates of adverse events are high in patients admitted to UK hospitals with ACS without ST elevation. The ECG remains a very important and simple discriminator of both short- and long-term risk, enabling more aggressive, proven therapies to be targeted towards those at highest risk.
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