There have been several attempts to...

There have been several attempts to identify the patients with unstable coronary artery disease (CAD) who will benefit the greatest in number from various treatment options. an studies have assessed examining the admission electrocardiogram (ECG) to determine if quantitative measurements of ST-T portions provide similar or better prognostic information than troponin measurements in patients with acute coronary syndrome In other trials, qualitative analysis of the ECG data alone or in combination with troponin T flats predicted treatment outcomes. There are popularly defined troponin levels that can be used as predictors in patients with acute coronary syndrome moreover the quantitative levels for an admission ECG have not been established. The objective of this meditation by Holmvang and associates was to evaluate which patients with non-ST-segment elevation acute coronary syndrome might benefit the principally from an early invasive treatment strategy.

The trial was a sub-study of the Fast Revascularization during InStability in Coronary artery disease trial (FRISC-II), a randomized research to evaluate early invasive intervention versus noninvasive intervention in patients with unstable CAD. Patients were enlisted if they had chest pain within the past 48 hours with elevation of the cardiac biomarkers, ST-segment depression, or T-wave inversion upon the admission ECG. In the invasive arm, patients received revascularization conducts within seven days of admission, while patients in the noninvasive arm received intervention solitary if they had refractory or returning symptoms or failed a discharge exercise ordeal An ECG was obtained in succession admission, at randomization, after the intervention, and at three-month and six-month follow-up visits. The ECG were analyzed for the vicinity and amount of ST-segment deviation and T-wave amplitudes. These ECG were then placed into quartiles based upon the amount of cumulative ST-segment deviation and the number of leads where this deviation was not past nor future Summed ST-deviation was divided into three groups: naught to 2.5 mm, 3 to 55 mm and 6 mm or larger. The number of leads where this deviation occurr was divided into three groups: naught to 4 leads, 5 to 7 leads, and 8 or more leads. Primary expiration points were death or myocardial infarction at six month Secondary issues were hospital re-admission, angina, myocardial revascularization, and bleeding.

There were 2201 patients who met the inclusion criteria for the close attention In terms of the primary issues of death and myocardial infarction, the intermediate and major ST-segment deviation assemblages (defined by the total amount of ST-segment deviation or the number of leads with ST-segment deviation) benefited more from the invasive strategy than from the noninvasive strategy. The invasive strategy in these assemblages provided an approximate 50 percent reduction in mortality and myocardial infarction rates. This finding was actual even when other variables of the like kind as gender, age, smoking, diabetes, hypertension, previous myocardial infarction, and elevated troponin flushs were controlled for in the analysis. The invasive strategy reduc mortality rates in all ECG subgroup object in patients with a cumulative total of ST-segment deviation of naught to 2.5 mm.

The authors terminate that complete quantitative analysis of the admission ECG in patients with acute coronary syndrome can identify the patients who would best benefit from invasive treatment strategy. They add that this is a readily available, easy, and inexpensive arrangement of risk stratifying patients with acute chest pain. When ECG data is evaluated carefully, it provides independent information in succession patient prognosis and the benefits of treatment.

Holmvang L et al. Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the chiefly from early invasive treatment. J Am Coll Cardiol March 19 2003; 41:905-15

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