ST depression in ECG at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease. The FRISC II ECG substudy

Diderholm, Erik; Andrén, Bertil; Frostfeldt, Gunnar; Genberg, Margareta; Jernberg, Tomas; Lagerqvist, Bo; Lindahl, Bertil; Wallentin, Lars

doi:10.1053/euhj.2001.2694

Cited by 117 publications

(43 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, patients presenting with chest pain and ST-segment deviation on ECG were considered to be part of a moderate-to high-risk subgroup, irrespective of other clinical risk factors or initial troponin measurements. This finding is consistent with results from previous studies, which have demonstrated an association between ST-segment depression and adverse prognosis in patients with acute coronary syndromes (24,25). Other independent predictors of 30-day events in our study included male sex, prior acetylsalicylic acid use, history of congestive heart failure and three or more cardiac risk factors.…”

Section: Risk Scoresupporting

confidence: 82%

Clinical risk scoring beyond initial troponin values: Results from a large, prospective, unselected acute chest pain population

McDonald

Holroyd

Comeau³

et al. 2007

Canadian Journal of Cardiology

View full text Add to dashboard Cite

Section: Risk Scoresupporting

confidence: 82%

Clinical risk scoring beyond initial troponin values: Results from a large, prospective, unselected acute chest pain population

McDonald

Holroyd

Comeau³

et al. 2007

Canadian Journal of Cardiology

View full text Add to dashboard Cite

“…Because a widespread use of an early invasive therapeutic strategy in the large and heterogeneous population of patients with non-ST-segment elevation AMI might be costineffective 29,30 or even harmful in those at the lowest risk, 31 identification of the subsets likeliest to benefit from this strategy is a focus of continued attention. 12,13 Accordingly, and in view of its association with severe coronary artery disease, ST-segment elevation in lead aVR could be used, if the results of the present study are confirmed in the large databases now available, as a readily available tool for an early selection of patients for coronary angiography and revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…1 The ECG has been extensively used for this purpose, and ST-segment depression on admission is now recognized as one of the strongest predictors of an adverse outcome. [2][3][4][5][6][7][8][9][10][11] In these patients, ST-segment depression has also been related to the presence of extensive coronary artery disease 3,6,8,12 and to a greater benefit of an early invasive therapeutic approach. 12,13 Lead aVR, whose positive pole is oriented to the right upper side of the heart, usually gives a mirror image of the leads oriented leftward, for which reason it is often ignored.…”

mentioning

confidence: 99%

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2003

View full text Add to dashboard Cite

Background-ST-segment elevation in lead aVR has been associated with severe coronary artery lesions in patients with acute coronary syndromes, but the prognostic significance of this finding is unknown. Methods and Results-We analyzed the initial ECG in 775 consecutive patients admitted to our center with a first acute myocardial infarction without ST-segment elevation in leads other than aVR or V 1 . The rates of in-hospital death in patients without (nϭ525) and with 0.05 to 0.1 mV (nϭ116) or Ն0.1 mV (nϭ134) of ST-segment elevation in lead aVR were 1.3%, 8.6%, and 19.4%, respectively (PϽ0.001). After adjustment for the baseline clinical predictors and for ST-segment depression on admission, the odds ratios for death in the last 2 groups were, respectively, 4.2 (95% CI, 1.5 to 12.2) and 6.6 (95% CI, 2.5 to 17.6). The rates of recurrent ischemic events and heart failure during hospital stay also increased in a stepwise fashion among the groups, whereas creatine kinase-MB levels were similar. Among the 437 patients that were catheterized within 6 months, the prevalence of left main or 3-vessel coronary artery disease in the 3 groups was 22.0%, 42.6%, and 66.3%, respectively (PϽ0.001). Conclusions-Lead aVR contains important short-term prognostic information in patients with a first non-ST-segment elevation acute myocardial infarction. Because the poorer outcome predicted by ST-segment elevation in lead aVR seems to be related to a more severe coronary artery disease, an early invasive approach might be especially beneficial in patients presenting with this finding.

show abstract

“…Although evidence supports T‐wave abnormality's adverse prognostic significance,4, 20, 21 our data for the first time indicate that myocardial edema may be the substrate for T‐wave abnormality.…”

Section: Discussionmentioning

confidence: 55%

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

show abstract

ST depression in ECG at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease. The FRISC II ECG substudy

Cited by 117 publications

References 16 publications

Clinical risk scoring beyond initial troponin values: Results from a large, prospective, unselected acute chest pain population

Clinical risk scoring beyond initial troponin values: Results from a large, prospective, unselected acute chest pain population

Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial Infarction

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Contact Info

Product

Resources

About