Prognostic value of the admission electrocardiogram in patients with unstable angina/non-ST-segment elevation myocardial infarction treated with very early revascularization

Abstract Study Question: The study goals were to determine if very early revascularization might ameliorate the adverse prognosis associated with ST-segment depression in patients with unstable angina/non-ST-segment elevation myocardial infarction (MI). Method: In this prospective cohort study, 1450 consecutive patients with unstable angina/non-ST-segment elevation MI were stratified by either the presence of ST-segment depression, T-wave inversion, or no changes on the admission electrocardiogram (ECG). All patients underwent coronary angiography and, if appropriate, revascularization within 24 h after admission. The primary end point of the study was all-cause mortality. Results: During up to 59 months of follow-up, the in-hospital mortality rate was 2.1% (19/895) in patients with no ECG changes, 4% (6/136) in those with ST-segment depression, and 0.2% (1/419) in those with no ECG changes, 19.9% (n=18) in at 36 months was 8.0% (n=49) in patients with no ECG changes, 19.9% (n=18) in patients with ST-segment depression, and 5.1% (n=13) in patients with T-wave inversion (p=0.0001 by log-rank). After adjustment for potential cofounders, ST-segment depression (hazard ratio [HR]=2.2; 95% confidence interval [CI]: 1.1–4.6) and T-wave inversion (HR=0.44; 95% CI: 0.20–0.96) were associated with long-term mortality. Conclusions: The researchers concluded that ST-segment depression and T-wave inversion on the admission ECG are important predictors of outcome in patients with unstable angina/non-ST-segment elevation MI and who are undergoing very early revascularization. Perspective: The study suggests that new ST-segment depression and new T-wave inversion on the admission ECG herald very different prognoses in patients with unstable angina/non-ST-segment elevation MI who undergo very early revascularization. In contrast to the considerable morbidity and mortality seen in patients with ST-segment depression, T-wave inversion appears to be associated with a more favorable outcome independent of potential cofounders, including gender. DM