Abstract

BackgroundThe impact of electrocardiography (ECG) morphology on clinical outcomes in patients with non-ST segment elevation myocardial infarction (NSTEMI) receiving percutaneous coronary intervention (PCI) is unknown. This study investigated whether different ST morphologies had different clinical outcomes in patients with NSTEMI receiving PCI.MethodsThis retrospective study analyzed record-linked data of 362 patients who had received PCI for NSTEMI between January 2008 and December 2010. ECG revealed ST depression in 67 patients, inverted T wave in 91 patients, and no significant ST-T changes in 204 patients. The primary endpoint was long-term all-cause mortality. The secondary endpoint was long-term cardiac death and non-fatal major adverse cardiac events.ResultsCompared to those patients whose ECG showed an inverted T wave and non-specific ST-T changes, patients whose ECG showed ST depression had more diabetes mellitus, advanced chronic kidney disease (CKD) and left main artery disease, as well as more in-hospital mortality, cardiac death and pulmonary edema during hospitalization. Patients with ST depression had a significantly higher rate of long-term total mortality and cardiac death. Finally, multiple stepwise Cox regression analysis showed that an advanced Killip score, age, advanced CKD, prior percutaneous transluminal coronary angioplasty and ST depression were independent predictors of the primary endpoint.ConclusionsAmong NSTEMI patients undergoing coronary angiography, those with ST depression had more in-hospital mortality and cardiac death. Long-term follow-up of patients with ST depression consistently reveals poor outcomes.

Highlights

  • According to clinical guidelines, the definition of non-ST segment elevation myocardial infarction (NSTEMI) is clinical chest tightness and elevation of cardiac enzyme without ST elevation on electrocardiography (ECG) (Nieto et al, 2007)

  • 409 patients who had a clinical diagnosis of NSTEMI received coronary angiography and percutaneous coronary intervention (PCI)

  • More of the patients with ST depression and T wave inversion had a past history of old MI and coronary artery bypass surgery (CABG) than the patients with no significant ST-T changes

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Summary

Introduction

The definition of non-ST segment elevation myocardial infarction (NSTEMI) is clinical chest tightness and elevation of cardiac enzyme without ST elevation on electrocardiography (ECG) (Nieto et al, 2007). No studies have focused on the impact of ECG patterns on long-term outcomes in this specific population after PCI. This study was aimed at evaluating the prognostic impact of clinical ECG patterns on clinical outcomes of NSTEMI patients undergoing PCI. The impact of electrocardiography (ECG) morphology on clinical outcomes in patients with non-ST segment elevation myocardial infarction (NSTEMI) receiving percutaneous coronary intervention (PCI) is unknown. Compared to those patients whose ECG showed an inverted T wave and nonspecific ST-T changes, patients whose ECG showed ST depression had more diabetes mellitus, advanced chronic kidney disease (CKD) and left main artery disease, as well as more in-hospital mortality, cardiac death and pulmonary edema during hospitalization. Patients with ST depression had a significantly higher rate of long-term total mortality and cardiac death. Long-term follow-up of patients with ST depression consistently reveals poor outcomes

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