Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease

Lene Holmvang*, Karl Andersen, Mikael Dellborg, Peter Clemmensen, Galen Wagner, Peer Grande, Putte Abrahamsson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)

Abstract

Patients with unstable coronary syndromes are a heterogeneous group with varying degrees of ischemia and prognosis. The present study compares the prognostic value of a standard electrocardiogram (ECG) obtained at admission to the hospital with the information from 24-hour continuous electrocardiographic monitoring obtained immediately after admission. The admission ECGs and 24 hours of vectorcardiographic (VCG) monitoring from 308 patients admitted with unstable coronary artery disease were analyzed centrally regarding standard electrocardiographic ST-T changes, ST-vector magnitude (ST-VM), and ST change vector magnitude episodes. End points were death, acute myocardial infarction, and refractory angina pectoris within a 30-day follow-up period. ST-VM episodes (≥50 μV for ≥1 minute) during VCG monitoring was the only independent predictor of death or acute myocardial infarction by multivariate analysis. ST-VM episodes during vectorcardiography was associated with a relative risk of 12.7 for having a cardiac event, hypertension was associated with a relative risk of 1.7, and ST depression on the admission ECG was associated with a relative risk of 5.7. Patients with ST depression at admission had an event rate (death or acute myocardial infarction) of 17% at 30-day follow-up. Patients without ST depression could further be risk stratified by 24 hours of VCG monitoring into a subgroup with ST-VM episodes at similar (8%) risk and a subgroup without ST-VM episodes at low (1%) risk (p = 0.00005). Continuous VCG monitoring provides important information for evaluating patients with unstable coronary artery disease. It is recommended that patients not initially estimated at high risk based on the admission ECG are referred for 24 hours of VCG monitoring for further risk stratification.

Original languageEnglish
Pages (from-to)667-674
Number of pages8
JournalAmerican Journal of Cardiology
Volume83
Issue number5
DOIs
Publication statusPublished - 1 Mar 1999

Bibliographical note

Funding Information:
This study was supported by grants from The Beckett Foundation, Copenhagen, Denmark; “Asta Floridan Boldings Mindelegat,” Copenhagen, Denmark; and the “Murermester Laurits Peter Christensen og hustru Kirsten Sigrid Christensens fond,” Hillerod, Denmark. Statistical support was financed through a grant from the Danish Medical Research Council. The TRIM study was planned and funded by ASTRA, ASTRA/Hässle AB, Molndal, Sweden.

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