QJM Advance Access published online on July 28, 2006
QJM, doi:10.1093/qjmed/hcl079
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1 From the Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK; From the Chelsea and Westminster Healthcare NHS Trust, London, UK
* To whom correspondence should be addressed. 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.
Received January 24, 2006
Accepted May 17, 2006
Original Papers
Admission ECG predicts long-term outcome in acute coronary syndromes without ST elevation
J. Collinson 1 *, A. Bakhai 2, A. Taneja 3, D. Wang 4, and M.D. Flather 5
2 From the Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK; From the Barnet and Chase Farm NHS Trust, London, UK
3 From the Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK
4 From the Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
5 From the Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK; National Heart and Lung Institute, Imperial College School of Medicine, London, UK
J. Collinson, E-mail: julian.collinson{at}chelwest.nhs.uk
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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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