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European Heart Journal 2002 23(14):1093-1101; doi:10.1053/euhj.2001.3043
Copyright © 2002 by the European Society of Cardiology.
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Continuous multilead ST-monitoring identifies patients with unstable coronary artery disease who benefit from extended antithrombotic treatment

T. Jernberga,f1, P. Abrahamssonb, B. Lindahla, P. Johansonb, L. Wallentina and M. Dellborgb

a Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden
b Department of Medicine and Cardiology, Sahlgrenska University Hospital, Östra, Gothenburg, Sweden

revised September 26, 2001; accepted October 10, 2001

Abstract

Aims Prolongation of anticoagulant treatment might reduce subsequent cardiac events in patients with unstable coronary artery disease. Multilead ST-segment monitoring identifies patients with a high risk of adverse outcome. The aim was to assess the value of multilead ST-monitoring in prospectively identifying patients who respond to extended anticoagulant treatment with low-molecular weight heparin when treated by a primarily non-invasive strategy.

Methods and Results In this substudy of the FRISC II trial, ST-monitoring with a continuous 12-lead ECG or vectorcardiography was performed for 24h in 629 patients with unstable coronary artery disease randomized to receive either the low-molecular weight heparin dalteparin, or placebo for 3 months after at least 5 days' dalteparin treatment in all patients. Ischaemic episodes were detected in 34% during ST-monitoring. In the group with ischaemic episodes, the extended dalteparin treatment was associated with a lower rate of death, myocardial infarction, or revascularization (35·2% vs 53·4%, relative risk reduction: 34%, P=0·01). In patients without ischaemic episodes, long-term dalteparin treatment had no effect.

Conclusions In patients with unstable coronary artery disease treated primarily with a non-invasive strategy, ischaemic episodes revealed while on multilead ST-monitoring identifies patients who benefit most from extended treatment with anticoagulants. Copyright 2001 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Electrocardiography, ST-monitoring, troponin T, unstable angina, myocardial infarction, prognosis, low-molecular weight heparin

f1 Correspondence: Tomas Jernberg, MD, Department of Cardiology, Cardiothoracic Center, University Hospital, 751 85 Uppsala, Sweden.


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