Abstract
Background: Continuous 12‐lead electrocardiographic (ECG) ST monitoring and the Thrombolysis In Myocardial Infarction Risk Score (TIMI‐RS), both have been shown to be useful for early risk stratification in patients with non‐ST elevation acute coronary syndromes (NSTACS).
Hypothesis: Transient ST ischemic events, detected by continuous 12‐lead ECG ST monitoring, early in the course of NSTACS, may add prognostic information to the TIMI‐RS.
Methods: In all, 567 consecutive patients with a NSTACS underwent 24‐h continuous 12‐lead ECG ST monitoring. An ST ischemic event was defined as a transient ST shift in any lead of ≥ 0.10 mV compared with the reference ECG, lasting for ≥l min.
Results: The incidence of the composite of death, nonfatal myocardial infarction (or reinfarction) and recurrent ischemia by Day 14 was 22.2%. By Day 30, the incidence of the composite of death and nonfatal myocardial infarction (or reinfarction) was 14.7%. There was a significantly increased risk of 14‐day (p value for trend < 0.001) or 30‐day (p value for trend <0.001) composite endpoint with increasing of TIMI‐RS. Moreover, the occurrence of ≥ 1 ST shifts during ST monitoring was associated with a significantly increased risk of 14‐(p value < 0.001) or 30‐day (p value < 0.001) composite end‐point, and this was true throughout the groups of TIMI‐RS.
Conclusions: The present study suggests that continuous 12‐lead ECG ST monitoring, early in the course of NSTACS, may serve as an affordable tool to add prognostic information to the TIMI‐RS.
Keywords: TIMI Risk Score, acute coronary syndromes, continuous 12‐lead ECG ST monitoring, prognosis
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