الفهرس 
Acute Coronary SyndromeOnly 14 pages are availabe for public view
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Abstract
The clinical assessment of patients admitted to hospital with acute chest pain suggestive of coronary artery disease is often a diagnostic challenge.
Physicians in busy hospital settings sometimes have to rely on incomplete data in their decision- making process, and some of the tests (e.g. ECG, troponine) must be repeated to make the diagnosis reliable. On the other hand timing is crucial to begin aggressive∕ invasive therapy in high-risk subjects.
The aim of this study is to assess the prognostic value of the global extent of ST-segment depression in non ST-elevation acute coronary syndrome.
The study included 109 patients with mean age (59±11) years, 42 females (38.5%) and 67 males (61.5%) presented to the emergency department in Ain Shams University hospital and National Heart Institute (NHI) in the period from April, 2006 to June, 2008 complaining from non ST-segment elevation acute coronary syndrome.
All patients included in the study were subjected to full history taking, full clinical examination, electrocardiography, full laboratory investigations, echocardiography, coronary angiography and followed up in hospital and for one month post - discharge for MACE (including cardiac death, myocardial infarction, unstable angina and LV failure).
For purposes of our analysis, ST segment depression was categorized into three groups:
1) ST segment depression ≤2 mm in two contiguous leads.
2) ST segment depression >2mm but <6mm in two contiguous leads; and
3) ST segment depression ≥6 mm in two contiguous leads.
This study adds two important pieces of information for improving risk stratification. First, even a minimal amount of transient ST-segment elevation is prognostically important. Secondly, significant prognostic information may be obtained by taking into account the amount of ST-segment depression across all 11 leads.
The present study was performed in patients with ACS with ischaemic ECG changes at hospital presentation; the presence of isolated ST-segment depression without T-wave inversion was confirmed as a marker of relatively benign outcome regarding 30-day death (X2=5.324; p-value 0.378; table 12) and 30-day death or MI (X2=3.173; p-value 0.673; table 20).
whereas the combination of ST-segment depression and T-wave inversion or isolated T-wave inversion was associated with worse outcomes regarding 30-day death (table 12) and 30-day death or MI (table 20)
The most important finding of the present study is that, from all ECG variables, the extent of ST-segment depression (Sum of ST-segment depression 11 leads) is a powerful, independent predictor of 30-day death (F=1.299; p-value <0.01; table 62) and 30-day death or MI (F=0.329; p-value <0.01; table 63).
Also in the multivariate analysis including clinical, ECG, echocardiographic and coronary angiographic variables, we found age, heart rate, hypertension, elevated CKMB on admission and positive troponine on admission were significant predictors of 30 day death (Table 62). Also we found age, heart rate, hypertension, diabetes, previous angina and killip class IV were significant predictors of 30 day death or MI (Table 63).
The conclusion is that the global sum of ST segment depression is an independent and important modulator of the risk of short-term death (30 day outcome) and should be incorporated into early evaluations.