In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
Abstract:
Introduction: In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), early identification of left main or 3-vessel disease (LM/3VD) is important in selecting the optimal treatment strategy. Hypothesis: ST-segment elevation in lead aVR (ST↑aVR) at presentation is considered a useful predictor of LM/3VD; however, time from symptom onset to presentation may influence its predictive value. Methods: We studied 835 patients with NSTE-ACS undergoing coronary angiography during hospitalization. We evaluated ECG findings and troponin T (TnT), estimated glomerular filtration rate (eGFR), brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and TIMI risk score on admission. Results: The prevalence of LM/3VD was 21%. Patients with LM/3VD were older (70±11 vs 66±11 yrs), had higher rates of hypertension (72% vs 64%), diabetes mellitus (51% vs 30%), Killip class ≥2 (31% vs 6%), positive-troponin T (≥0.1 ng/ml) (57% vs 29%), and ST↑aVR ≥0.5 mm (79% vs 15%), and had higher levels of BNP (367±407 vs 184±398 pg/ml), hsCRP (0.908±2.564 vs 0.371±1.425 mg/dl), and summed ST-segment depression (9±7 vs 2±3 mm), and TIMI risk score (3.7±1.2 vs 2.6±1.4) and a lower eGFR (54±27 vs 66±24 ml/min/1.73 m2), and a higher rate of in-hospital death, (re)infarction, or urgent revascularization (36% vs 9%) than did those without LM/3VD (all p 〈 0.05). Multivariate analysis showed that ST↑aVR (OR 10.8, 95%CI 3.88-20.1, p 〈 0.01) was the strongest predictor of LM/3VD, and followed by positive-troponin T (OR 2.20, 95%CI 1.26-4.01, p 〈 0.01). When patients were subdivided according to the 6-h time window from symptom onset, the predictive values of ST↑aVR for the diagnosis of LM/3VD were significantly higher than those of positive-troponin T, except the sensitivity in delayed presentation (Table). Conclusions: In patients with NSTE-ACS, ST↑aVR on admission strongly predicted LM/3VD; however, its sensitivity decreased in delayed ( 〉 6 h) presentation.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.132.suppl_3.9739
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2015
detail.hit.zdb_id:
1466401-X
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