Prognostic value of ischemia monitoring with on-line vectorcardiography in patients with unstable coronary artery disease

• <i>Aim:</i> The aim of this study was to determine whether on-line vectorcardiography (VCG) gives independent prognostic information, regarding death, myocardial infarction (MI), and revascularization in patients with unstable coronary artery disease, i.e. unstable angina or non-Q-wave MI. <i>Methods and Results:</i> One hundred and fifty patients (mean age 69 ± 10), participating in a randomized study of low-molecular-weight heparin in unstable coronary artery disease, were studied with on-line VCG recordings for 24 h. During a 5–6-month follow-up, 11 patients died, 14 suffered a nonfatal MI and 31 were revascularized. Univariate predictors of death were diabetes mellitus (p < 0.01), maximum ST vector magnitude (ST-VM; p < 0.001), maximum ST change vector magnitude (STC-VM; p < 0.001), number of ST-VM (p < 0.01) and STC-VM episodes (p < 0.001). In multivariate analysis, the number of STC-VM episodes (p < 0.01) and diabetes mellitus (p < 0.02) each gave independent prognostic information regarding death. When all cardiovascular events were combined, the inhability to perform an exercise test (p < 0.05), maximum value of ST-VM (p < 0.01) and STC-VM (p < 0.001), the number of episodes of STC-VM (p < 0.001) and ST-VM (p < 0.001) all gave prognostic information. In multivariate analysis, the inability to perform an exercise test and the number of STC-VM episodes were independent predictors. <i>Conclusion:</i> VCG monitoring during the first 24 h of hospitalization for unstable coronary artery disease gives independent prognostic information.

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