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ST segment shift in unstable angina: pathophysiology and association with coronary anatomy and hospital outcome
A Langer1, M R Freeman, P W Armstrong
1Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
Insights
ST segment shift on electrocardiograms (ECG) indicates higher risk for adverse outcomes in unstable angina patients. This finding highlights the importance of ECG monitoring for predicting coronary artery disease severity and patient prognosis.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Electrocardiography
Background:
- ST segment deviation on electrocardiograms (ECG) is a critical indicator in acute coronary syndromes.
- Unstable angina requires accurate prognostic markers to guide timely intervention.
Purpose of the Study:
- To evaluate the association between ST segment shift and coronary anatomy.
- To assess the relationship between ST segment shift and in-hospital outcomes in unstable angina patients.
Main Methods:
- Analysis of 135 unstable angina patients.
- Comparison of ST segment shift on admission ECG and Holter monitor ECG.
- Correlation of ST shift presence and duration with coronary artery disease extent and clinical outcomes.
Main Results:
- ST segment shift was observed in 44% on admission ECG and 66% on Holter monitoring.
- Patients with ST shift showed significantly higher rates of unfavorable outcomes (48-55%), multivessel disease (76-77%), and left main coronary artery stenosis (18-22%).
- Longer ST shift duration correlated with adverse outcomes, multivessel disease, and left main stenosis.
Conclusions:
- ST segment shift is a significant predictor of adverse outcomes and complex coronary artery disease in unstable angina.
- ECG monitoring, including Holter, is crucial for risk stratification in unstable angina.
- Early identification of ST shift can aid in clinical decision-making and patient management.
Abstract:
The significance of ST segment shift with respect to coronary anatomy and hospital outcome was evaluated in 135 patients with unstable angina. ST shift was evident in 44% of patients on admission electrocardiogram (ECG) and in 66% on Holter monitor ECG. During hospitalization, 7% of patients had myocardial infarction, 4% died and 34% had urgent coronary revascularization. By comparing patients with and without ST shift on admission ECG, an unfavorable outcome was found in 55% versus 25% (p less than 0.005), multivessel disease in 77% versus 63% (p less than 0.05) and left main coronary artery stenosis in 22% versus 7% (p less than 0.025). When patients with and without ST shift on Holter monitor ECG were compared, an unfavorable outcome was found in 48% versus 20% (p less than 0.005), multivessel disease in 76% versus 54% (p less than 0.01) and left main coronary stenosis in 18% versus 4% (p less than 0.05). The duration of ST shift was also greater in patients with 1) unfavorable outcome (129 +/- 136 versus 52 +/- 111 min, p less than 0.01); 2) multivessel disease (98 +/- 129 versus 36 +/- 90 min, p less than 0.01); and 3) left main stenosis (150 +/- 147 versus 67 +/- 114 min, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)