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Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease.
I Nyman1, M Areskog, N H Areskog
1Department of Internal Medicine, District Hospital, Eksjo, Sweden.
Insights
Resting electrocardiograms (ECGs) can predict cardiac events in patients with suspected unstable coronary heart disease. ECG findings, unlike cardiac enzymes, offer early prognostic stratification for risk stratification.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Preventive Medicine
Background:
- Unstable coronary heart disease (UCHD) requires early risk stratification.
- Prognostic markers are crucial for timely intervention in UCHD patients.
Purpose of the Study:
- To assess the early prognostic value of resting electrocardiograms (ECGs) and cardiac enzymes in patients with suspected UCHD.
- To determine if ECG findings can stratify risk for adverse cardiac events.
Main Methods:
- A cohort of 911 men with suspected unstable angina or non-Q-wave myocardial infarction was studied.
- Resting ECGs and creatinine kinase levels were monitored during hospitalization.
- Patients were followed for 12 months for cardiac death, myocardial infarction, or severe angina.
Main Results:
- Patients with abnormal ECGs had significantly higher risks of cardiac events compared to those with normal ECGs.
- ST depression (18%) and combined ST elevation/depression (26%) indicated the highest risks.
- Cardiac enzyme levels showed no predictive value for future cardiac events.
Conclusions:
- Resting ECGs performed early in hospitalization provide valuable prognostic information for UCHD patients.
- ECG patterns can effectively stratify risk, aiding in early clinical decision-making.
- Cardiac enzyme levels were not found to be predictive in this cohort.
Objectives:
To determine the possibility of very early prognostic stratification based on electrocardiograms (ECGs) at rest and/or cardiac enzyme levels after an episode of suspected unstable coronary heart disease.
Design And Setting:
Men with suspected unstable angina or non-Q-wave myocardial infarction were studied in the coronary care units of eight hospitals. The ECGs at rest and creatinine kinase were followed.
Subjects:
In total 911 men were followed for 12 months. Of 8136 consecutively admitted, 3365 fulfilled the inclusion criteria. Excluded were 2454 patients, mainly because of a larger myocardial damage, signs of myocardial dysfunction, other serious cardiac or non-cardiac disease or an ECG not possible to interpret regarding ST-T-segment changes in the precordial leads.
Main Outcome Measures:
End-points at follow-up were cardiac death, myocardial infarction and severe (class III or IV) angina.
Results:
Compared to patients with normal a ECG who had an 8% 1-year risk of myocardial infarction or death, the risk with isolated negative T waves was 14% (P < 0.05), ST elevation 16% (P < 0.05), ST depression 18% (P < 0.01) and the combination of ST elevation and ST depression 26% (P < 0.001). The only finding related to future severe angina was ST depression. The risk of cardiac events was comparably elevated in patients with anterior or inferior site of ECG changes. Cardiac enzyme levels had no predictive value regarding future events.
Conclusions:
Electrocardiograms at rest obtained during the initial days of hospitalization provide very early and valuable prognostic information in men admitted with suspected unstable coronary heart disease.