Prognostic implications of increased cardiac biomarkers and ST segment depression in non-ST elevation acute coronary syndromes: lessons from the acute coronary syndrome Israeli survey (ACSIS) 2002

Ben‐Dor, Itsik

doi:10.1136/hrt.2005.069625

Cited by 12 publications

(13 citation statements)

References 3 publications

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“…25,26 The role played by the pro-inflammatory cytokines IL-6, 9 TNF-a, 10 and IL-1b 27 in inflammation in MS is well documented. The increase in hsCRP observed in our study subjects with MS is consistent with other reports [28][29][30] and indicates the chronic inflammatory state of these individuals. However, the contribution of T cell-derived cytokines towards MS-specific inflammation is less well known.…”

Section: Discussionsupporting

confidence: 95%

Increased Levels of Both Th1 and Th2 Cytokines in Subjects with Metabolic Syndrome (CURES-103)

Surendar

Mohan

Rao

et al. 2011

Diabetes Technology & Therapeutics

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Section: Discussionsupporting

confidence: 95%

Increased Levels of Both Th1 and Th2 Cytokines in Subjects with Metabolic Syndrome (CURES-103)

Surendar

Mohan

Rao

et al. 2011

Diabetes Technology & Therapeutics

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“…2,3,14 Several studies have found that ST-segment depression in leads other than lead aVR combined with troponin levels on admission is useful for the evaluation of NSTE-ACS. 11,14,15 Holmvang et al showed that baseline values of troponins T and I combined with ST-T changes at presentation were useful for predicting death or myocardial infarction at 30 days in patients with unstable coronary artery disease. 15 Kaul et al noted that positive troponin T was associated with a higher risk of death or myocardial infarction at 6 months within each ST-segment depression category (no, 0.1 mV, and 0.2 mV ST-segment depression) among patients with NSTE-ACS.…”

Section: Combined Prognostic Utility Of Ecg and Biomarkersmentioning

confidence: 99%

“…3,[6][7][8][9][10][11][12][13][14][15] Therefore, the clinical significance of STsegment deviation in lead aVR in patients with NSTE-ACS remains poorly understood. Several studies have found analysis of lead aVR to be useful for the evaluation of NSTE-ACS.…”

Section: St-segment Elevation In Lead Avrmentioning

confidence: 99%

“…3,[6][7][8][9][10][11][12][13][14][15] The presence of even minimal (0.05 mV) ST-segment depression has been shown to be independently associated with adverse outcomes. 6 Furthermore, the degree and extent of ST-segment depression, not only its presence or absence, strongly correlate with the severity and outcomes of coronary artery disease.…”

Section: St-segment Depressionmentioning

confidence: 99%

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Clinical Implications of Electrocardiograms for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes in the Interventional Era

Kosuge

Kimura

2009

Circ J

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Circ J 2009; 73: 798 -805 atients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are heterogeneous with regard to both the underlying pathophysiology and the future risk of cardiac events. 1 Early risk stratification is crucial for appropriate management of this condition and for deciding whether early invasive strategies should be adopted. 2 Because of its simplicity, safety, widespread availability and low cost, the electrocardiogram (ECG) has been extensively used for risk stratification. The ECG plays a central role in diagnostic and triage pathways for NSTE-ACS and provides important prognostic information in the current interventional era. Importance of ECG in Risk StratificationTwo treatment strategies have emerged for the early management of NSTE-ACS: one strategy is invasive, and the other is conservative. General consensus has been reached that patients at higher risk benefit more from early invasive strategies, increasing the importance of appropriate risk stratification. Recently, biomarkers of myocardial damage (troponin), inflammation (C-reactive protein), hemodynamic stress (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and renal function (creatinine) have also been linked to the risk of subsequent cardiac events. [3][4][5] However, the GUSTO-IV (Global Utilization of Strategies to Open Occluded Arteries-IV ACS) trial of 7,800 patients with NSTE-ACS has highlighted the striking prognostic value of ST-segment depression on admission as compared with independent factors, including expanded biomarker profiles as well as traditional risk factors (Figure 1). 3 The ECG thus continues to have important roles in prognosis as well as in diagnosis and selection of the optimal treatment strategy in patients with NSTE-ACS. ST-Segment DepressionST-segment changes are considered the most important electrocardiographic feature during acute myocardial ischemia. In patients with transmural ischemia, ST-segment elevation is present in leads facing the site of ischemia. Therefore, the ischemia-related artery can be predicted on the basis of the leads showing ST-segment elevation during ischemic attacks. Whereas in many patients with non-transmural ischemia, ST-segment depression occurs in leads V4 to V6 leads (mainly in lead V5) independently of the ischemiarelated artery, in which underlying mechanism remains unclear. It is thus difficult to predict the ischemia-related artery on the basis of these leads. On exercise thallium myocardial scintigraphy, however, the site of a reversible decrease in blood flow corresponds to the region supplied by the ischemia-related artery, even in patients who have ST-segment depression in leads V4 to V6 (primarily lead V5) during myocardial ischemia.The presence of acute ischemic changes on the admission ECG has been associated with a higher risk of cardiac events; ST-segment depression is an especially strong predictor of poor outcomes in patients with NSTE-ACS. 3,[6][7][8][9][10][11][12][13][14][15] The presence of even minimal (0.05 ...

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“…From 2000 to 2010, 11,538 patients (76% male, mean age 64 6 13 years) with ACS (45% with ST-segment elevation myocardial infarction [STEMI]) were included in six consecutive ACSIS enrollment waves [5][6][7][8]. Patient management was at the discretion of the attending physicians and according to cardiology departments' policies.…”

mentioning

confidence: 99%

The ACSIS Registry and primary angioplasty following coronary bypass surgery

Kornowski

2011

Cathet Cardio Intervent

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Prognostic implications of increased cardiac biomarkers and ST segment depression in non-ST elevation acute coronary syndromes: lessons from the acute coronary syndrome Israeli survey (ACSIS) 2002

Cited by 12 publications

References 3 publications

Increased Levels of Both Th1 and Th2 Cytokines in Subjects with Metabolic Syndrome (CURES-103)

Increased Levels of Both Th1 and Th2 Cytokines in Subjects with Metabolic Syndrome (CURES-103)

Clinical Implications of Electrocardiograms for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes in the Interventional Era

The ACSIS Registry and primary angioplasty following coronary bypass surgery

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