Copyright © 2002 by the European Society of Cardiology.
ST depression in ECG at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease. The FRISC II ECG substudy
a Department of Cardiology, University Hospital, Uppsala, Sweden
b Clinical Physiology, University Hospital, Uppsala, Sweden
revised March 14, 2001; accepted March 21, 2001
Abstract
Background In unstable coronary artery disease, ST-segment depression indicates a poor prognosis. We evaluated whether the effect of early revascularization and the extent of coronary lesions were related to ST-segment and T wave changes on admission.
Methods and Results 2457 patients with unstable coronary artery disease were randomized to an early invasive strategy with coronary angiography/revascularization within 7 days or to a non-invasive strategy with coronary procedures only when symptoms or severe ischaemia recurred. ST depression was present in 1114 (45¶5%) patients. In the invasive group, 45% of the patients with ST depression had three-vessel disease or left main stenosis compared with 22% if no ST-segment depression was present, PP=0¶004 while mortality was changed from 5¶8 to 3¶3%, P=0¶050. In patients without ST-segment depression the corresponding rates concerning death/myocardial infarction were 10¶4 and 8¶9, and for mortality 2¶0 and 1¶2% (non-significant).
Conclusions In unstable coronary artery disease, ST-segment depression is associated with a 100% increase in the occurrence of three-vessel/left main disease and to an increased risk of subsequent cardiac events. In these patients an early invasive strategy substantially decreases death/myocardial infarction.
Key Words: Unstable angina, coronary angiography, coronary angioplasty, coronary bypass, electrocardiography, myocardial infarction
f1 Correspondence: Erik Diderholm, MD, Department of Cardiology, Cardiothoracic Center, University Hospital, S-751 85 Uppsala, Sweden.
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