IN ACUTE CORONARY SYNDROME PATIENTS WITH ST SEGMENT
DEPRESSION HAVE IMPROVED LATE SURVIVAL FOLLOWING EARLY REVASCULARISATION. JK. French*, TA. Hyde, CK. Wong, RML.
Whitlock, HD. White. Green Lane Hospital, Auckland, New Zealand. Improved short-term clinical outcomes following early revascularisation,
in patients with non-persistent ST segment elevation acute coronary
syndromes (NSTACS), appears to occur mainly in patients with ST
segment depression (ST dep). To determine the effect of in-hospital
revascularisation (early revasc) on late outcome, we prospectively
evaluated 370 NSTACS patients with presenting electrocardiograms
(ECGs) admitted in 1993 (86% Braunwald class IIIB); 39 patients
with old left bundle branch block or paced rhythm were excluded.
The vital status of 99% was determined at 52 (interquartile range
48-55) months. Of 328 patients, 123 had >1mm ST
dep of whom 50 underwent early revasc, and 205 ST dep <1mm (no
ST dep [0.5mm ST dep (50), T wave inversion (57) or normal ECG (98)]),
of whom 108 underwent early revasc. In patients with ST dep,
late survival was improved following early revasc, compared to those
without early revasc (p<0.05). Early revasc did not affect
survival in patients with no ST dep. In conclusion, the survival benefit of
early revascularisation in NSTAC, is in patients with >1mm ST segment
depression.
