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Utility of the ST-segment deviation score in the risk prediction of patients with suspected acute myocardial infarction

Session Poster Session 1

Speaker Raphael Twerenbold

Event : ESC Congress 2013

  • Topic : e-cardiology / digital health, public health, health economics, research methodology
  • Sub-topic : Cardiovascular Signal Processing
  • Session type : Poster Session

Authors : R Twerenbold (Basel,CH), T Reichlin (Basel,CH), R Abaecherli (Basel,CH), S Sou (Basel,CH), K Wildi (Basel,CH), P Haaf (Basel,CH), T Hochgruber (Basel,CH), M Reiter (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , T. Reichlin1 , R. Abaecherli1 , S. Sou1 , K. Wildi1 , P. Haaf1 , T. Hochgruber1 , M. Reiter1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland ,

Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 27

Purpose: ST-segment deviation score (STDS), a summation of all ST-segment deviations from baseline in a standard 12-lead ECG, has shown to correlate with mortality in patients with acute coronary syndrome. However, it is unknown whether these findings can be generalized to the clinical important setting of unselected patients presenting with acute chest pain, in which the early and reliable detection of patients at higher risk still presents an unmet clinical need.

Methods: In this prospective multicenter study STDS was determined in 1336 consecutive patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction. Primary endpoint was the occurrence of death within 30 and 360 days. Patients with left ventricular hypertrophy or bundle branch block were excluded. The STDS was defined as the sum in millimeters (1mm = 1mV) of the absolute value of ST-segment deviations in all 12 leads of the first recorded ECG.

Results: STDS at presentation in the highest tertile (≥4.8mm) compared to the intermediate or lowest tertile (<2.7mm) was associated with an increased risk for death in the ensuing 30 days (HR 5.5, p<0.001) and 360 days (HR 3.9, p<0.001). Multivariate analysis showed that initial STDS levels remained an independent predictor of death within 30 days after adjustment for high-sensitive cardiac troponin T levels at presentation (HR 5.2, p=0.002) or TIMI-risk score (HR 5.5, p<0.001).

Conclusions: STDS, a simple and easily feasible clinical tool, helps in the risk stratification of unselected patients presenting with acute chest pain to the ED, as it independently predicts the short and long term mortality in this clinical important setting.

ClinicalTrials.gov number, NCT00470587.

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