Abstract 12606: The Influence of Presenting Electrocardiographic Findings on the Treatment and Outcomes of Patients With Non-ST-elevation Myocardial Infarction (NSTEMI)
BACKGROUND: The influence of presenting ECG findings on the treatment and outcomes of NSTEMI patients has not been studied in current practice.
METHODS: We analyzed clinical characteristics, in-hospital management, and in-hospital outcomes of NSTEMI patients in the ACTION Registry®-GWTGTM according to the presenting ECG. A total of 175,556 patients from 485 sites from January 2007 to September 2011 were stratified by ECG findings on presentation: ST depression (ST-D, n=40146), T-Wave Inversions (TWI, n=24627), Transient ST Elevation (TSTE, n=5050), and no ischemic ECG changes (None, n=105733).
RESULTS: Patients presenting with ST-D were the oldest and had the greatest prevalence of major cardiac risk factors (Table). Coronary angiography was performed most frequently in the TSTE group, followed by the TWI, ST-D, and none groups, respectively. The angiogram revealed three vessel coronary artery disease (CAD) to be most frequent in the ST-D group; one vessel CAD was most frequent in the TSTE group. On the corollary, the ST-D group underwent coronary artery bypass grafting the most and the TSTE group underwent percutaneous coronary intervention the most. Unadjusted mortality was highest in the ST-D group, followed by none, TSTE and TWI groups, respectively. Adjusted mortality utilizing the ACTION-GWTG in-hospital mortality model with the none group as a referent was equal to TSTE (OR 1.15; 95% CI 0.97 - 1.37; p = 0.1048), higher in the ST-D group (OR 1.46; 95% CI 1.4 - 1.5; p<0.0001) and lower in the TWI group (OR 0.91; 95% CI 0.83 - 0.99; p = 0.0261).
CONCLUSIONS: Clinical and angiographic characteristics of NSTEMI patients differ substantially based on the presenting ECG. Patients with ST depression have a greater burden of co-morbidities and have a higher risk of adjusted in-hospital mortality compared with the other groups. These findings highlight the importance of integrating the presenting ECG findings into the risk stratification algorithm for patients with NSTEMI.
- © 2012 by American Heart Association, Inc.