Copyright © 2003 by the European Society of Cardiology.
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Does the discharge ECG provide additional prognostic insight(s) in non-ST elevation ACS patients from that acquired on admission?
a University of Alberta, 2-51 Medical Science Building, Edmonton, Alberta, Canada T6G 2H7
b Duke Clinical Research Institute, Durham, NC, USA
c University Hospital Gasthuisberg, Leuven, Belgium
* Corresponding author. Tel.: +1-780-492-0591; fax: +1-780-492-9486
E-mail address: paul.armstring{at}ualberta.ca
Received 16 June 2002; accepted 24 July 2002
Background Although the prognostic value of admission ST changes in patients with non-ST elevation acute coronary syndrome (ACS) is established, the utility of the discharge ECG is unknown. Accordingly, using the PARAGON-B Troponin substudy, we assessed the prevalence of ST depression on both admission and discharge ECG, the likelihood of developing new Q-waves at discharge and the additional prognostic value of these changes.
Methods and results Nine hundred and eighteen patients were studied; 542 patients (59%) had admission ST
1mm and 376 patients (41%) did not and their 6-month mortality was 4.4 vs 0.8%, 
, respectively. Of patients with ST on admission, 320 (59%) normalized their ST segment at discharge. Of patients without ST on admission, 35 (9.3%) developed new ST at discharge. Patients with persistent ST on discharge had a higher 6-month mortality (6.0 vs 0.9%), (re)MI (16.3 vs 7.4%), and death/(re)MI (20.0 vs 8.3%) than those who never had ST (all 
). Two hundred and fifty-six patients had Q-waves on admission whereas by discharge 320 had Q-waves. Patients with Q-waves on discharge vs those without had a higher mortality (4.8 vs 1.9%), (re)MI (13.8 vs 8.3%), and death/(re)MI (16.4 vs 9.6%) at 6 months (all 
).
Conclusions This study highlights that the dynamic ECG changes which occur between admission and discharge in non-ST elevation ACS patients allows further risk stratification in determining the likelihood of 6-month death and/or re(MI).
Key Words: Unstable angina • Non-Q wave MI • Electrocardiogram
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- Management of non ST-segment elevation acute coronary syndromes—continuing the search for the bad guys
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EHJ 2003 24: 490-493.[Extract] [FREE Full Text]
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  J Thambyrajah and M.A De Belder Management of non ST-segment elevation acute coronary syndromes--continuing the search for the bad guys Eur. Heart J., March 2, 2003; 24(6): 490 - 493. [Full Text] [PDF]
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