Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression

• Published in: The American journal of cardiology 1999-08, Vol.84 (4), p.379-385
• Main Authors: Hyde, Thomas A, French, John K, Wong, Cheuk-Kit, Straznicky, Ivan T, Whitlock, Ralph M.L, White, Harvey D
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Angina, Unstable - mortality; Angina, Unstable - physiopathology; Angina, Unstable - therapy; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Drug Therapy, Combination; Electrocardiography, Ambulatory; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Heart; Heparin - therapeutic use; Hospital Mortality; Humans; Male; Medical research; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Revascularization; Patients; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Prospective Studies; Severity of Illness Index; Survival Rate
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)00319-7

We prospectively evaluated all patients admitted to our coronary care unit during 1993 with ischemic chest pain but without ST-segment elevation on the presenting electrocardiogram, and determined the influence of the extent of ST-segment depression, measured using calipers and blinded to the outcome, on 4-year survival. The presenting symptoms of 367 patients (mean age 64 years) were coded according to the Braunwald classification, 86% being in class IIIB (primary unstable angina with rest angina within 48 hours) and 7.4% in class IIIC (postinfarction angina). Thirty-two patients (8.6%) had myocardial infarction at presentation (defined as a creatine kinase level exceeding twice the reference range within 18 hours). During hospitalization 97% of patients received aspirin, 67% received intravenous heparin, 37% underwent angiography, and 35% underwent revascularization. The vital status of 99% of the patients was determined after a median of 52 months (interquartile range 48 to 55). At follow-up, 88% of patients were taking aspirin, 45% were taking β blockers, and 50% had undergone revascularization. The survival rate was 70% in patients with ≥0.5-mm ST-segment depression (53%, 77%, and 82% survival for ≥2-, 1-, and 0.5-mm ST-segment depression, respectively; p