Copyright © 2001 by the European Society of Cardiology.
Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients
a The Thoraxcenter, University Hospital Rotterdam, The Netherlands
b Cardialysis, Clinical Research Management and Core Laboratories, Rotterdam, The Netherlands
c Division of Cardiology, Medical Center Alkmaar, The Netherlands
revised March 27, 2001; accepted April 21, 2001
Abstract
Aims Recurrent ischaemia, detected by continuous ECG monitoring, in patients with unstable angina increases the risk of unfavourable outcome. Studies that evaluated this relationship have been limited by the small series of patients. By combining data from three studies, the present analysis aims to provide an accurate assessment of the impact of recurrent ischaemia detected by multilead ECG-ischaemia monitoring on the occurrence of death and myocardial infarction in patients with acute coronary syndromes.
Methods and Results Data were obtained from CAPTURE, PURSUIT and FROST, three trials evaluating glycoprotein IIb/IIIa blockers in patients with non-ST-elevation acute coronary syndromes. Patients were monitored for 24h after enrolment with a computer-assisted 12-lead or a vectorcardiographic ECG–ischaemia monitoring device. In a retrospective blinded analysis, recurrent ischaemic episodes were identified by a computer algorithm. The number of ischaemic episodes was normalized to 24h. Ischaemic episodes were detected in 271 (27%) of 995 patients. There was a direct proportional relationship between the number of ischaemic episodes per 24h and the probability of cardiac events at 5 and 30 days. The 30-day composite of death and myocardial infarction occurred in 5·7% of patients without episodes and increased to 19·7% in patients with 
5 episodes. After adjustment for baseline predictors of adverse outcome, the relative risk of death or myocardial infarction at 5 and 30 days increased by 25% for each additional ischaemic episode per 24h.
Conclusions This analysis emphasizes the need for integration of multilead ECG–ischaemia monitoring systems in coronary care units and emergency wards to improve early risk stratification in patients with acute coronary syndromes.
Key Words: Electrocardiography, ischaemia, acute coronary syndromes, unstable angina, ECG monitoring, prognosis
f1 Correspondence: K. Martijn Akkerhuis, MD, PhD, University Hospital Rotterdam, Room H 543, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. T. Yan, A. T. Yan, K. W. Mahaffey, H. D. White, K. Pieper, J.-L. Sun, C. J. Pepine, L. M. Biasucci, D. C. Gulba, J. Lopez-Sendon, et al. Prognostic utility of quantifying evolutionary ST-segment depression on early follow-up electrocardiogram in patients with non-ST-segment elevation acute coronary syndromes Eur. Heart J., December 23, 2009; (2009) ehp548v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Sandau and M. Smith Continuous ST-Segment Monitoring: 3 Case Studies in Progressive Care Crit. Care Nurse, October 1, 2009; 29(5): 18 - 27. [Full Text] [PDF]
|
|
|
|
|
|
K. E. Sandau and M. Smith Continuous ST-Segment Monitoring: Protocol for Practice Crit. Care Nurse, August 1, 2009; 29(4): 39 - 49. [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Scirica, D. A. Morrow, A. Budaj, A. J. Dalby, S. Mohanavelu, J. Qin, J. Aroesty, C. M. Hedgepeth, P. H. Stone, and E. Braunwald Ischemia Detected on Continuous Electrocardiography After Acute Coronary Syndrome: Observations From the MERLIN-TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction 36) Trial J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1411 - 1421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Tzivoni and M. W. Krucoff Continuous ST-Segment Monitoring in Contemporary Acute Coronary Syndrome Patients: The Magic of MERLIN-TIMI 36 J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1422 - 1424. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
|
|
|
|
|
|
R. P. Giugliano, S. D. Wiviott, P. H. Stone, D. I. Simon, M. J. Schweiger, A. Bouchard, M. A. Leesar, M. A. Goulder, S. R. Deitcher, C. H. McCabe, et al. Recombinant Nematode Anticoagulant Protein c2 in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: The ANTHEM-TIMI-32 Trial J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2398 - 2407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Simoons, I. W. G. Bobbink, J. Boland, M. Gardien, P. Klootwijk, A. W. A. Lensing, W. Ruzyllo, V. A. W. M. Umans, A. Vahanian, F. Van De Werf, et al. A dose-finding study of fondaparinux in patients with non-ST-segment elevation acute coronary syndromes: The Pentasaccharide in Unstable Angina (PENTUA) study J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2183 - 2190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
|
|
P.F. Cohn The value of continuous ST segment monitoring in patients with unstable angina Eur. Heart J., November 1, 2001; 22(21): 1972 - 1973. [PDF]
|
|