QJM Advance Access originally published online on July 28, 2006
QJM 2006 99(9):601-607; doi:10.1093/qjmed/hcl079
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Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation
From the 1Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, 2Chelsea and Westminster Healthcare NHS Trust, London, 3Barnet and Chase Farm NHS Trust, London, 4Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, and 5National Heart and Lung Institute, Imperial College School of Medicine, London, UK
Address correspondence to Dr J. Collinson, Department of Cardiology, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH. email: julian.collinson{at}chelwest.nhs.uk
Received 24 January 2006 and in revised form 17 May 2006
Background: Acute coronary syndromes (ACS) without ST elevation are a frequent cause of hospital admission, myocardial infarction and death.
Aim: To explore the role of the ECG in stratifying ACS patients.
Design: Prospective, centrally-coordinated multicentre registry involving 56 centres throughout the UK.
Methods: Consecutive patients admitted with ACS without ST elevation on the presenting ECG (n = 1046) were followed for 6 months. A subgroup (n = 653) were flagged with the UK Office for National Statistics and followed-up for death over 4 years.
Results: Mean follow-up for the group as a whole was 2.4 years. In the first 6 months, the death rate was 7.3%. Survival at 1 year was 90.8% (95%CI 88.2%–92.8%); at 45 months it was 77.8% (95%CI 74.1%–81.1%). We compared data in those with ST depression or bundle branch block on the admission ECG (n = 304, 29%) with those with T wave inversion, Q waves and minor ST segment changes (n = 576, 55%) and those with a normal ECG (n = 166, 16%). Their respective incidences of death were 15%, 5% and 2% (p < 0.01) at 6 months, and 38%, 22% and 7% (p < 0.01) at 4 years.
Discussion: Rates of adverse events are high in patients admitted to UK hospitals with ACS without ST elevation. The ECG remains a very important and simple discriminator of both short- and long-term risk, enabling more aggressive, proven therapies to be targeted towards those at highest risk.
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  O. M. Jolobe Guidelines for the diagnosis and treatment of non-ST segment elevation acute coronary syndromes Eur. Heart J., January 2, 2008; 29(2): 277 - 277. [Full Text] [PDF]
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