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. The Fast Revascularisation during InStability in Coronary artery disease

• Published in: European heart journal 2002-01, Vol.23 (1), p.41-49
• Main Authors: Diderholm, E, Andrén, B, Frostfeldt, G, Genberg, M, Jernberg, T, Lagerqvist, B, Lindahl, B, Wallentin, 2nd, L
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Comparative Study; Coronary Arteriosclerosis/complications/diagnosis/therapy; Coronary Artery Bypass; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Coronary Stenosis - complications; Coronary Stenosis - diagnosis; Coronary Stenosis - therapy; Coronary Stenosis/complications/diagnosis/therapy; Electrocardiography; Endpoint Determination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Patient Admission; Prognosis; Severity of Illness Index; Sweden - epidemiology; Treatment Outcome
• ISSN: 0195-668X

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. 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). 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.