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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

ST segment elevation with exercise: a marker for poor ventricular function and poor prognosis. Coronary Artery

R A Bruce1, L D Fisher, M Pettinger

  • 1Department of Medicine, University of Washington/the CASS Coordinating Center, Seattle.

Circulation
|April 1, 1988
PubMed

Insights

Exercise-induced ST elevation in coronary heart disease patients predicts poor survival, especially when combined with exercise and recovery phases. This finding is valuable before invasive cardiac studies.

Area of Science:

  • Cardiology
  • Clinical Exercise Physiology

Background:

  • Exercise-induced ST elevation (EISE) in coronary heart disease (CHD) patients has demonstrated prognostic significance.
  • Previous studies, like the Seattle Heart Watch (SHW), analyzed EISE using computer averaging.

Purpose of the Study:

  • To evaluate the functional and prognostic significance of EISE in a larger cohort of CHD patients.
  • To compare EISE findings between the Coronary Artery Surgery Study (CASS) and SHW cohorts.

Main Methods:

  • Analysis of 3050 patients from the CASS registry, examining initial findings, survival, and secondary coronary events over 6 years.
  • EISE in CASS patients was identified by visual interpretation (≥1 mm ST elevation), differing from the SHW's computer-averaged method.
  • Comparison of EISE prevalence and prognostic value between CASS and SHW cohorts.

Main Results:

  • The prevalence of EISE was lower in the CASS cohort (visual interpretation) compared to the SHW cohort (computer averaging).
  • CASS patients with EISE exhibited higher frequencies of prior myocardial infarction and left ventricular dysfunction.
  • Poor survival rates were similar in subgroups with EISE during exercise and recovery in both CASS and SHW.

Conclusions:

  • Exercise-induced ST elevation is a significant predictor of poor survival in coronary heart disease patients.
  • While not an independent predictor when invasive variables are known, EISE is a useful prognostic marker when exercise testing precedes invasive cardiac evaluations.

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