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Usefulness of the A...
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Damman, PeterUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
(author)
Usefulness of the Admission Electrocardiogram to Predict Long-Term Outcomes After Non-ST-Elevation Acute Coronary Syndrome (from the FRISC II, ICTUS, and RITA-3 [FIR] Trials)
- Article/chapterEnglish2012
Publisher, publication year, extent ...
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Elsevier BV,2012
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LIBRIS-ID:oai:DiVA.org:uu-165746
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165746URI
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https://doi.org/10.1016/j.amjcard.2011.08.002DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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The aim of this study was to evaluate the independent prognostic value of qualitative and quantitative admission electrocardiographic (ECG) analysis regarding long-term outcomes after non-ST-segment elevation acute coronary syndromes (NSTE-ACS). From the Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS), and Randomized Intervention Trial of Unstable Angina 3 (RITA-3) patient-pooled database, 5,420 patients with NSTE-ACS with qualitative ECG data, of whom 2,901 had quantitative data, were included in this analysis. The main outcome was 5-year cardiovascular death or myocardial infarction. Hazard ratios (HRs) were calculated with Cox regression models, and adjustments were made for established outcome predictors. The additional discriminative value was assessed with the category-less net reclassification improvement and integrated discrimination improvement indexes. In the 5,420 patients, the presence of ST-segment depression (≥1 mm; adjusted HR 1.43, 95% confidence interval [CI] 1.25 to 1.63) and left bundle branch block (adjusted HR 1.64, 95% CI 1.18 to 2.28) were independently associated with long-term cardiovascular death or myocardial infarction. Risk increases were short and long term. On quantitative ECG analysis, cumulative ST-segment depression (≥5 mm; adjusted HR 1.34, 95% CI 1.05 to 1.70), the presence of left bundle branch block (adjusted HR 2.15, 95% CI 1.36 to 3.40) or ≥6 leads with inverse T waves (adjusted HR 1.22, 95% CI 0.97 to 1.55) was independently associated with long-term outcomes. No interaction was observed with treatment strategy. No improvements in net reclassification improvement and integrated discrimination improvement were observed after the addition of quantitative characteristics to a model including qualitative characteristics. In conclusion, in the FRISC II, ICTUS, and RITA-3 NSTE-ACS patient-pooled data set, admission ECG characteristics provided long-term prognostic value for cardiovascular death or myocardial infarction. Quantitative ECG characteristics provided no incremental discrimination compared to qualitative data.
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Holmvang, LeneCopenhagen Univ Hosp, Ctr Heart, Copenhagen, Denmark
(author)
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Tijssen, Jan G PUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
(author)
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Lagerqvist, Bo,1952-Uppsala universitet,Kardiologi(Swepub:uu)bolager
(author)
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Clayton, Tim CLondon Sch Hyg & Trop Med, London WC1, England
(author)
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Pocock, Stuart JLondon Sch Hyg & Trop Med, London WC1, England
(author)
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Windhausen, FonsUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
(author)
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Hirsch, AlexanderUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
(author)
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Fox, Keith A ARoyal Infirm, Dept Med & Radiol Sci, Edinburgh, Midlothian, Scotland
(author)
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Wallentin, Lars,1943-Uppsala universitet,Kardiologi(Swepub:uu)larswall
(author)
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de Winter, Robbert JUniv Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, Netherlands
(author)
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Univ Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1105 AZ Amsterdam, NetherlandsCopenhagen Univ Hosp, Ctr Heart, Copenhagen, Denmark
(creator_code:org_t)
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In:American Journal of Cardiology: Elsevier BV109:1, s. 6-120002-91491879-1913
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Damman, Peter
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Holmvang, Lene
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Tijssen, Jan G P
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Lagerqvist, Bo, ...
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Clayton, Tim C
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Pocock, Stuart J
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Windhausen, Fons
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Hirsch, Alexande ...
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Fox, Keith A A
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- MEDICAL AND HEALTH SCIENCES
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Uppsala University