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Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?

Publication ,  Journal Article
Hersi, A; Fu, Y; Wong, B; Mahaffey, KW; Harrington, RA; Califf, RM; Van de Werf, F; Armstrong, PW; PARAGON-B Investigators,
Published in: Eur Heart J
March 2003

BACKGROUND: Although the prognostic value of admission ST changes in patients with non-ST elevation acute coronary syndrome (ACS) is established, the utility of the discharge ECG is unknown. Accordingly, using the PARAGON-B Troponin substudy, we assessed the prevalence of ST depression on both admission and discharge ECG, the likelihood of developing new Q-waves at discharge and the additional prognostic value of these changes. METHODS AND RESULTS: Nine hundred and eighteen patients were studied; 542 patients (59%) had admission ST downward arrow > or =1mm and 376 patients (41%) did not and their 6-month mortality was 4.4 vs 0.8%, P=0.002, respectively. Of patients with ST downward arrow on admission, 320 (59%) normalized their ST segment at discharge. Of patients without ST downward arrow on admission, 35 (9.3%) developed new ST downward arrow at discharge. Patients with persistent ST downward arrow on discharge had a higher 6-month mortality (6.0 vs 0.9%), (re)MI (16.3 vs 7.4%), and death/(re)MI (20.0 vs 8.3%) than those who never had ST downward arrow (all P< or =0.002). Two hundred and fifty-six patients had Q-waves on admission whereas by discharge 320 had Q-waves. Patients with Q-waves on discharge vs those without had a higher mortality (4.8 vs 1.9%), (re)MI (13.8 vs 8.3%), and death/(re)MI (16.4 vs 9.6%) at 6 months (all P< or =0.021). CONCLUSIONS: This study highlights that the dynamic ECG changes which occur between admission and discharge in non-ST elevation ACS patients allows further risk stratification in determining the likelihood of 6-month death and/or re(MI).

Duke Scholars

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

March 2003

Volume

24

Issue

6

Start / End Page

522 / 531

Location

England

Related Subject Headings

  • Tyrosine
  • Troponin T
  • Survival Analysis
  • Prognosis
  • Platelet Aggregation Inhibitors
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Hersi, A., Fu, Y., Wong, B., Mahaffey, K. W., Harrington, R. A., Califf, R. M., … PARAGON-B Investigators, . (2003). Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission? Eur Heart J, 24(6), 522–531. https://doi.org/10.1016/s0195-668x(02)00525-0
Hersi, A., Y. Fu, B. Wong, K. W. Mahaffey, R. A. Harrington, R. M. Califf, F. Van de Werf, P. W. Armstrong, and P. W. PARAGON-B Investigators. “Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?Eur Heart J 24, no. 6 (March 2003): 522–31. https://doi.org/10.1016/s0195-668x(02)00525-0.
Hersi A, Fu Y, Wong B, Mahaffey KW, Harrington RA, Califf RM, et al. Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission? Eur Heart J. 2003 Mar;24(6):522–31.
Hersi, A., et al. “Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?Eur Heart J, vol. 24, no. 6, Mar. 2003, pp. 522–31. Pubmed, doi:10.1016/s0195-668x(02)00525-0.
Hersi A, Fu Y, Wong B, Mahaffey KW, Harrington RA, Califf RM, Van de Werf F, Armstrong PW, PARAGON-B Investigators. Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission? Eur Heart J. 2003 Mar;24(6):522–531.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

March 2003

Volume

24

Issue

6

Start / End Page

522 / 531

Location

England

Related Subject Headings

  • Tyrosine
  • Troponin T
  • Survival Analysis
  • Prognosis
  • Platelet Aggregation Inhibitors
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female