Prognostic value of the admission electrocardiogram in acute coronary syndromes.

摘要: ContextThe presence of ischemic changes on electrocardiogram (ECG) correlates with poorer outcomes in patients acute chest pain.ObjectiveTo determine the prognostic value various ECG presentations myocardial ischemia.DesignRetrospective analysis presenting ECGs of patients enrolled Global Use Strategies To Open Occluded Arteries Acute Coronary Syndromes (GUSTO-IIb).SettingThree hundred seventy-three hospitals 13 countries in North America, Europe, Australia, and New Zealand.PatientsA total 12,142 who reported symptoms of cardiac ischemia at rest within 12 hours admission had signs of confirmed by ECG. On ECG, 22% T-wave inversion, 28% ST-segment elevation, 35% had ST-segment depression, 15% a combination ST-segment elevation depression.Main Outcome MeasureAbility ECG to predict death or myocardial reinfarction during first 30 days follow-up.ResultsThe 30-day incidence or reinfarction was 5.5% 9.4% those with ST-segment 10.5% and 12.4% elevation depression (P<.001). After adjusting for factors associated an increased risk reinfarction, compared who had inversion only, odds reinfarction were 1.68 (95% confidence interval [CI], 1.36-2.08) 1.62 CI, 1.32-1.98) 2.27 1.80-2.86) with combined depression. An elevated creatine kinase level at admission correlated higher (odds ratio [OR], 2.36; 95% 1.92-2.91) (OR, 1.56; CI, 1.32-1.85). The category admission remained highly predictive infarction after multivariate adjustment significant baseline predictors of events.ConclusionsThe presentation allows immediate risk stratification across spectrum coronary syndromes. An elevated is worse outcomes.