American Journal of Cardiology
Volume 101, Issue 7 , Pages 919-924 , 1 April 2008

Usefulness of Quantitative Versus Qualitative ST-Segment Depression for Risk Stratification of Non-ST Elevation Acute Coronary Syndromes in Contemporary Clinical Practice

  • Raymond T. Yan, MD

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Andrew T. Yan, MD

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Christopher B. Granger, MD

      Affiliations

    • Duke University Medical Center, Durham, North Carolina
    • ,
  • Jose Lopez-Sendon, MD

      Affiliations

    • Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
    • ,
  • David Brieger, MD

      Affiliations

    • Department of Cardiology, Concord Hospital, Sydney, Australia
    • ,
  • Brian Kennelly, MB, ChB, PhD

      Affiliations

    • Hoag Memorial Hospital, Presbyterian, Newport Beach, California
    • ,
  • Andrzej Budaj, MD, PhD

      Affiliations

    • Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
    • ,
  • Ph. Gabriel Steg, MD

      Affiliations

    • Département de Cardiologie, Hôpital Bichat-Claude Bernard, Paris, France.
    • ,
  • Alina A. Georgescu, MD

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Quamrul Hassan, MD

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Shaun G. Goodman, MD, MSc

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
    • Corresponding Author InformationCorresponding author: Tel: 416-864-5722; fax: 416-864-5407.
    • ,
  • Global Registry of Acute Coronary Events (GRACE) Electrocardiogram Substudy Group

      Affiliations

    • A list of participating GRACE Electrocardiogram Substudy Investigators and Coordinators appears in the Appendix.

References 

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  2. Savonitto S, Ardissino D, Granger CB, Morando G, Mafrici A, Lee KL, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA. 1999;281:707–713
  3. Krone RJ, Greenberg H, Dwyer EM, Klieger RE, Boden WE. Long-term prognostic significance of ST-segment depression during acute myocardial infarction. J Am Coll Cardiol. 1993;22:361–367
  4. Antman EM, Cohen M, Bernink JLM, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000;284:835–842
  5. Boersma E, Pieper KS, Steyerberg EW, Wilcox RG, Chang W-C, Lee KL, et al Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9461 patients. Circulation. 2000;101:2557–2567
  6. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003;163:2345–2353
  7. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndromes: prospective multinational observational study. BMJ. 2006;333:1091–1094
  8. Kaul P, Fu Y, Chang W-C, Harrington RA, Wagner GS, Goodman SG, et al Prognostic value of ST segment depression in acute coronary syndromes: insights from PARAGON-A applied to GUSTO-IIb. J Am Coll Cardiol. 2001;38:64–71
  9. Kaul P, Newby K, Fu Y, Hasselblad V, Mahaffey KW, Christenson RH, et al Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk stratification of acute coronary syndromes patients. J Am Coll Cardiol. 2003;41:371–380
  10. Savonitto S, Cohen MG, Alessandro P, Hudson MP, Kong DF, Huang Y, et al Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2005;26:2106–2113
  11. Westerhout CM, Fu Y, Lauer MS, Hames S, Armstrong PW, Al-Hattab E, et al. Short- and long-term risk stratification in acute coronary syndromes. J Am Coll Cardiol. 2006;48:939–947
  12. Yan AT, Yan RT, Tan M, Chow C-M, Fitchett DH, Georgescu AA, et al. ST-segment depression in non-ST elevation acute coronary syndromes: quantitative analysis may not provide incremental prognostic value beyond comprehensive risk stratification. Am Heart J. 2006;152:270–276
  13. The GRACE Investigators. Rational and design of the GRACE (Global Registry of Acute Coronary Events) project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001;141:190–199
  14. Steg PG, Goldberg RJ, Gore JM, Fox KA, Eagle KA, Flather MD, et al. Baseline characteristics, management practices, and in-hospital outcome of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol. 2002;90:358–363
  15. Fu Y, Goodman S, Chang W-C, Van de Werf F, Granger CB, Armstrong PW. Time to treatment influences the impact of ST-segment resolution on one-year prognosis (Insight from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) trial). Circulation. 2001;104:2653–2659
  16. Goodman SG, Barr A, Langer A, Wagner GS, Fitchett D, Armstrong PW, et al. Development and prognosis of non-Q-wave myocardial infarction in the thrombolytic era. Am Heart J. 2002;144:243–250
  17. Hyde TA, French JK, Wong C-K, Straznicky IT, Whitlock RML, White HD. Four-year survival of patients with acute coronary syndromes without ST-segment elevation and prognostic significance of 0.5-mm ST-segment depression. Am J Cardiol. 1999;84:379–385
  18. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristics curves derived from the same cases. Radiology. 1983;148:839–843
  19. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al American College of Cardiology; American Heart Association (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366–1374
  20. Yan AT, Jong P, Yan RT, Tan M, Fitchett D, Chow C-M, et al. Clinical trial-derived risk model may not generalize to real-world patients with acute coronary syndromes. Am Heart J. 2004;148:1080–1027

 The Global Registry of Acute Coronary Events (GRACE) and GRACE Electrocardiogram Substudy were sponsored by Sanofi-Aventis, Bridgewater, New Jersey. The sponsor had no involvement in the study conception or design; collection, analysis, and interpretation of data; writing, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr. Yan is supported by the Canadian Institutes of Health Research Fellowship award and the Detweiler Travelling Fellowship from the Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.

PII: S0002-9149(07)02322-3

doi: 10.1016/j.amjcard.2007.11.041

American Journal of Cardiology
Volume 101, Issue 7 , Pages 919-924 , 1 April 2008

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