Abstract 3211: Baseline Clinical Risk and Recurrent Ischemia as Detected on Continuous ECG (CECG) Monitoring in Patients with non-ST-Elevation Acute Coronary Syndrome in the MERLIN-TIMI 36 Trial
Background: To evaluate the association between the TIMI Risk Score (TRS) for NSTEACS (UA/NSTEMI) and subsequent ischemia detected on CECG monitoring.
Methods: MERLIN-TIMI 36 randomized 6560 pts with NSTEACS to the anti-ischemic agent ranolazine or placebo. Median clinical f/u was approx 12 months. At randomization, 3-lead CECG monitoring was initiated for a median of 6.9 days. Recurrent ischemia on CECG was defined as ST dep ≤1mm lasting ≤1 min. The TRS is calculated as the sum of 7 presenting characteristics (age ≤65 yrs, ≤3 cardiac risk factors, documented CAD, recent severe angina, ST dev ≤0.5 mm, elevated cardiac markers, prior ASA use) and categorized as low(0 –2), moderate(3– 4), or high(>4) risk.
Results: A total of 30.2% pts were low risk (TRS 0 –2), 52.5% were moderate risk TRS (3– 4) and 17.3% were high risk (TRS 5–7). Ischemia was detected on CECG in 1239/6355(19.5%) pts with 633(10.0%) experiencing >2 episodes. Pts with higher TRS were more likely to experience any ischemic episode (13.5% in low TRS v 19.1% in moderate TRS v 31.1% in high TRS, p<0.001) and >2 episodes (5.5% v 10.1% v. 17.3%, p<0.001). Among patient who experienced ischemia, those with higher TRS had a longer total duration of ischemia (66.5 v 102.3 v 115.5 min. p<0.001). Overall and within each TRS risk category, ischemia detected on CECG was associated with worse CV outcomes. (Figure⇓)
Conclusions: Recurrent ischemia as detected on CECG was more frequent among pts with higher clinical risk as determined by the TRS. Even among pts with a similar baseline risk by TRS, subsequent recurrent ischemia on CECG was associated with worse long-term cardiovascular outcomes