Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression
We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcom...
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| Veröffentlicht in: | The American journal of cardiology 1999-08, Vol.84 (4), p.379-385 |
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| creator | Hyde, Thomas A French, John K Wong, Cheuk-Kit Straznicky, Ivan T Whitlock, Ralph M.L White, Harvey D |
| description | We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcome, on 4-year survival. The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had myocardial infarction at presentation (defined as a creatine kinase level exceeding twice the reference range within 18 hours). During hospitalization 97% of patients received aspirin, 67% received intravenous heparin, 37% underwent angiography, and 35% underwent revascularization. The vital status of 99% of the patients was determined after a median of 52 months (interquartile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45% were taking β blockers, and 50% had undergone revascularization. The survival rate was 70% in patients with ≥0.5-mm ST-segment depression (53%, 77%, and 82% survival for ≥2-, 1-, and 0.5-mm ST-segment depression, respectively; p |
| doi_str_mv | 10.1016/S0002-9149(99)00319-7 |
| format | Article |
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The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had myocardial infarction at presentation (defined as a creatine kinase level exceeding twice the reference range within 18 hours). During hospitalization 97% of patients received aspirin, 67% received intravenous heparin, 37% underwent angiography, and 35% underwent revascularization. The vital status of 99% of the patients was determined after a median of 52 months (interquartile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45% were taking β blockers, and 50% had undergone revascularization. The survival rate was 70% in patients with ≥0.5-mm ST-segment depression (53%, 77%, and 82% survival for ≥2-, 1-, and 0.5-mm ST-segment depression, respectively; p <0.0001). Patients with a normal electrocardiogram had a greater survival rate (94%) than that of patients with 0.5-mm ST-segment depression (82%, p = 0.020), but not significantly different from that of patients with T-wave inversion (84%, p = NS). Independent predictors of mortality (odds ratio [95% confidence interval]) were: age in yearly increments (1.05 [1.03 to 1.06], p = 0.003), revascularization during follow-up (0.40 [0.29 to 0.56], p = 0.006), pulmonary edema (3.45 [2.19 to 5.45], p = 0.007), and ST-segment depression (1.37 [1.20 to 1.55], p = 0.015). Thus, ST-segment depression of ≥0.5 mm predicts 4-year survival in patients with acute ischemic syndromes.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(99)00319-7</identifier><identifier>PMID: 10468072</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Aged ; Angina, Unstable - mortality ; Angina, Unstable - physiopathology ; Angina, Unstable - therapy ; Aspirin - therapeutic use ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Coronary heart disease ; Drug Therapy, Combination ; Electrocardiography, Ambulatory ; Female ; Fibrinolytic Agents - therapeutic use ; Follow-Up Studies ; Heart ; Heparin - therapeutic use ; Hospital Mortality ; Humans ; Male ; Medical research ; Medical sciences ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocardial Revascularization ; Patients ; Platelet Aggregation Inhibitors - therapeutic use ; Prognosis ; Prospective Studies ; Severity of Illness Index ; Survival Rate</subject><ispartof>The American journal of cardiology, 1999-08, Vol.84 (4), p.379-385</ispartof><rights>1999 Excerpta Medica Inc.</rights><rights>1999 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. 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The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had myocardial infarction at presentation (defined as a creatine kinase level exceeding twice the reference range within 18 hours). During hospitalization 97% of patients received aspirin, 67% received intravenous heparin, 37% underwent angiography, and 35% underwent revascularization. The vital status of 99% of the patients was determined after a median of 52 months (interquartile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45% were taking β blockers, and 50% had undergone revascularization. The survival rate was 70% in patients with ≥0.5-mm ST-segment depression (53%, 77%, and 82% survival for ≥2-, 1-, and 0.5-mm ST-segment depression, respectively; p <0.0001). Patients with a normal electrocardiogram had a greater survival rate (94%) than that of patients with 0.5-mm ST-segment depression (82%, p = 0.020), but not significantly different from that of patients with T-wave inversion (84%, p = NS). Independent predictors of mortality (odds ratio [95% confidence interval]) were: age in yearly increments (1.05 [1.03 to 1.06], p = 0.003), revascularization during follow-up (0.40 [0.29 to 0.56], p = 0.006), pulmonary edema (3.45 [2.19 to 5.45], p = 0.007), and ST-segment depression (1.37 [1.20 to 1.55], p = 0.015). Thus, ST-segment depression of ≥0.5 mm predicts 4-year survival in patients with acute ischemic syndromes.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Aged</subject><subject>Angina, Unstable - mortality</subject><subject>Angina, Unstable - physiopathology</subject><subject>Angina, Unstable - therapy</subject><subject>Aspirin - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Coronary heart disease</subject><subject>Drug Therapy, Combination</subject><subject>Electrocardiography, Ambulatory</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heparin - therapeutic use</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Revascularization</subject><subject>Patients</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Survival Rate</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkdFqFDEUhoModq0-ghJERC-mnmQmm8mVSLEqFLxovQ7Z5MyaMpOsyczKPkjft5nOosUbr0LI958c_o-QlwzOGLD1hysA4JVijXqn1HuAmqlKPiIr1kpVMcXqx2T1Bzkhz3K-KVfGxPopOWHQrFuQfEVuL-KUqgOaRPOU9n5veho7ujOjxzBm-tuPP6mx04jUxhSDSQeaD8GlOODyGqeRXl1XGbdDSVDscV_CMVATHN2luA0xj97S7LfBd96aYHH-As5ENQwPow53CXMu2efkSWf6jC-O5yn5cfH5-vxrdfn9y7fzT5eVbZgcK4QO1q1RYJysN5Y7kM62KBh3Sthmg8rW4LhsRQcMuo5zzjZWccukYa5l9Sl5u8wte_6aMI968Nli35uAccpazg0KMYOv_wFvSm-h7KZ5DbWoBYgCiQWyKeacsNO75IfSmGagZ2n6XpqejWil9L00LUvu1XH4tBnQPUgtlgrw5giYbE3fpdKhz3851cCCfVwwLJXtPSadbbFo0fmEdtQu-v9scgfvbrWD</recordid><startdate>19990815</startdate><enddate>19990815</enddate><creator>Hyde, Thomas A</creator><creator>French, John K</creator><creator>Wong, Cheuk-Kit</creator><creator>Straznicky, Ivan T</creator><creator>Whitlock, Ralph M.L</creator><creator>White, Harvey D</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>19990815</creationdate><title>Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression</title><author>Hyde, Thomas A ; French, John K ; Wong, Cheuk-Kit ; Straznicky, Ivan T ; Whitlock, Ralph M.L ; White, Harvey D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-e0f068a90ad73bc2d07dc8e512d95c4be9c30d2785f010ff2221bc92c17a1d813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Aged</topic><topic>Angina, Unstable - mortality</topic><topic>Angina, Unstable - physiopathology</topic><topic>Angina, Unstable - therapy</topic><topic>Aspirin - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Coronary heart disease</topic><topic>Drug Therapy, Combination</topic><topic>Electrocardiography, Ambulatory</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heparin - therapeutic use</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Revascularization</topic><topic>Patients</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hyde, Thomas A</creatorcontrib><creatorcontrib>French, John K</creatorcontrib><creatorcontrib>Wong, Cheuk-Kit</creatorcontrib><creatorcontrib>Straznicky, Ivan T</creatorcontrib><creatorcontrib>Whitlock, Ralph M.L</creatorcontrib><creatorcontrib>White, Harvey D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hyde, Thomas A</au><au>French, John K</au><au>Wong, Cheuk-Kit</au><au>Straznicky, Ivan T</au><au>Whitlock, Ralph M.L</au><au>White, Harvey D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1999-08-15</date><risdate>1999</risdate><volume>84</volume><issue>4</issue><spage>379</spage><epage>385</epage><pages>379-385</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcome, on 4-year survival. The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had myocardial infarction at presentation (defined as a creatine kinase level exceeding twice the reference range within 18 hours). During hospitalization 97% of patients received aspirin, 67% received intravenous heparin, 37% underwent angiography, and 35% underwent revascularization. The vital status of 99% of the patients was determined after a median of 52 months (interquartile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45% were taking β blockers, and 50% had undergone revascularization. The survival rate was 70% in patients with ≥0.5-mm ST-segment depression (53%, 77%, and 82% survival for ≥2-, 1-, and 0.5-mm ST-segment depression, respectively; p <0.0001). Patients with a normal electrocardiogram had a greater survival rate (94%) than that of patients with 0.5-mm ST-segment depression (82%, p = 0.020), but not significantly different from that of patients with T-wave inversion (84%, p = NS). Independent predictors of mortality (odds ratio [95% confidence interval]) were: age in yearly increments (1.05 [1.03 to 1.06], p = 0.003), revascularization during follow-up (0.40 [0.29 to 0.56], p = 0.006), pulmonary edema (3.45 [2.19 to 5.45], p = 0.007), and ST-segment depression (1.37 [1.20 to 1.55], p = 0.015). Thus, ST-segment depression of ≥0.5 mm predicts 4-year survival in patients with acute ischemic syndromes.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10468072</pmid><doi>10.1016/S0002-9149(99)00319-7</doi><tpages>7</tpages></addata></record> |
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| subjects | Adrenergic beta-Antagonists - therapeutic use Aged Angina, Unstable - mortality Angina, Unstable - physiopathology Angina, Unstable - therapy Aspirin - therapeutic use Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Coronary heart disease Drug Therapy, Combination Electrocardiography, Ambulatory Female Fibrinolytic Agents - therapeutic use Follow-Up Studies Heart Heparin - therapeutic use Hospital Mortality Humans Male Medical research Medical sciences Middle Aged Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocardial Revascularization Patients Platelet Aggregation Inhibitors - therapeutic use Prognosis Prospective Studies Severity of Illness Index Survival Rate |
| title | Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression |
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