Usefulness of Quantitative Versus Qualitative ST-Segment Depression for Risk Stratification of Non-ST Elevation Acute Coronary Syndromes in Contemporary Clinical Practice
Identifieur interne : 008941 ( Main/Exploration ); précédent : 008940; suivant : 008942Usefulness of Quantitative Versus Qualitative ST-Segment Depression for Risk Stratification of Non-ST Elevation Acute Coronary Syndromes in Contemporary Clinical Practice
Auteurs : Raymond T. Yan [Canada] ; Andrew T. Yan [Canada] ; Christopher B. Granger [États-Unis] ; Jose Lopez-Sendon [Espagne] ; David Brieger [Australie] ; Brian Kennelly [États-Unis] ; Andrzej Budaj [Pologne] ; Ph. Gabriel Steg [France] ; Alina A. Georgescu [Canada] ; Quamrul Hassan [Canada] ; Shaun G. Goodman [Canada]Source :
- The American journal of cardiology [ 0002-9149 ] ; 2008.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Analyse quantitative.
English descriptors
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Abstract
This aim of this study was to assess the clinical utility of quantitative ST-segment depression (STD) for refining the risk stratification of non-ST elevation acute coronary syndromes in the prospective, multinational Global Registry of Acute Coronary Events (GRACE). Quantitative measurements of STD on admission electrocardiograms were evaluated independently by a core laboratory, and their predictive value for in-hospital and cumulative 6-month mortality was examined. Although more severe STD is a marker of increased short- and long-term mortality, it is also associated with higher risk clinical features and biomarkers. Thus, after adjustment for these clinically important predictors, quantitative STD does not provide incremental prognostic value beyond simple dichotomous evaluation for the presence of STD. Furthermore, adopting quantitative instead of the prognostically proven qualitative evaluation of STD does not improve risk discrimination afforded by the validated GRACE risk models. In conclusion, the findings do not support the quantification of STD in routine clinical practice beyond simple evaluation for the presence of STD as an integral part of comprehensive risk stratification using the GRACE risk score.
Affiliations:
- Australie, Canada, Espagne, France, Pologne, États-Unis
- Californie, Caroline du Nord, Communauté de Madrid, Nouvelle-Galles du Sud, Ontario, Île-de-France
- Madrid, Paris, Sydney, Toronto
- Université de Toronto
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Yan</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Yan, Andrew T" sort="Yan, Andrew T" uniqKey="Yan A" first="Andrew T." last="Yan">Andrew T. Yan</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Duke University Medical Center</s1><s2>Durham, North Carolina</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Lopez Sendon, Jose" sort="Lopez Sendon, Jose" uniqKey="Lopez Sendon J" first="Jose" last="Lopez-Sendon">Jose Lopez-Sendon</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Cardiology Department, Hospital Universitario La Paz</s1><s2>Madrid</s2><s3>ESP</s3><sZ>4 aut.</sZ></inist:fA14><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Cardiology, Concord Hospital</s1><s2>Sydney</s2><s3>AUS</s3><sZ>5 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Kennelly, Brian" sort="Kennelly, Brian" uniqKey="Kennelly B" first="Brian" last="Kennelly">Brian Kennelly</name><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>Hoag Memorial Hospital, Presbyterian</s1><s2>Newport Beach, California</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Postgraduate Medical School, Grochowski Hospital</s1><s2>Warsaw</s2><s3>POL</s3><sZ>7 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Steg, Ph Gabriel" sort="Steg, Ph Gabriel" uniqKey="Steg P" first="Ph. Gabriel" last="Steg">Ph. Gabriel Steg</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Département de Cardiologie, Hôpital Bichat-Claude Bernard</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Georgescu, Alina A" sort="Georgescu, Alina A" uniqKey="Georgescu A" first="Alina A." last="Georgescu">Alina A. Georgescu</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Hassan, Quamrul" sort="Hassan, Quamrul" uniqKey="Hassan Q" first="Quamrul" last="Hassan">Quamrul Hassan</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">The American journal of cardiology</title><title level="j" type="abbreviated">Am. j. cardiol.</title><idno type="ISSN">0002-9149</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The American journal of cardiology</title><title level="j" type="abbreviated">Am. j. cardiol.</title><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute coronary syndrome</term><term>Cardiology</term><term>Circulatory system</term><term>Comparative study</term><term>Professional practice</term><term>Quantitative analysis</term><term>Risk</term><term>Risk factor</term><term>ST depression</term><term>ST elevation</term><term>Stratification</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Analyse quantitative</term><term>Etude comparative</term><term>Sousdécalage ST</term><term>Facteur risque</term><term>Risque</term><term>Stratification</term><term>Susdécalage ST</term><term>Pratique professionnelle</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Syndrome coronaire aigu</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Analyse quantitative</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">This aim of this study was to assess the clinical utility of quantitative ST-segment depression (STD) for refining the risk stratification of non-ST elevation acute coronary syndromes in the prospective, multinational Global Registry of Acute Coronary Events (GRACE). Quantitative measurements of STD on admission electrocardiograms were evaluated independently by a core laboratory, and their predictive value for in-hospital and cumulative 6-month mortality was examined. Although more severe STD is a marker of increased short- and long-term mortality, it is also associated with higher risk clinical features and biomarkers. Thus, after adjustment for these clinically important predictors, quantitative STD does not provide incremental prognostic value beyond simple dichotomous evaluation for the presence of STD. Furthermore, adopting quantitative instead of the prognostically proven qualitative evaluation of STD does not improve risk discrimination afforded by the validated GRACE risk models. In conclusion, the findings do not support the quantification of STD in routine clinical practice beyond simple evaluation for the presence of STD as an integral part of comprehensive risk stratification using the GRACE risk score.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>Espagne</li><li>France</li><li>Pologne</li><li>États-Unis</li></country><region><li>Californie</li><li>Caroline du Nord</li><li>Communauté de Madrid</li><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Île-de-France</li></region><settlement><li>Madrid</li><li>Paris</li><li>Sydney</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Yan, Raymond T" sort="Yan, Raymond T" uniqKey="Yan R" first="Raymond T." last="Yan">Raymond T. Yan</name></region><name sortKey="Georgescu, Alina A" sort="Georgescu, Alina A" uniqKey="Georgescu A" first="Alina A." last="Georgescu">Alina A. Georgescu</name><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><name sortKey="Hassan, Quamrul" sort="Hassan, Quamrul" uniqKey="Hassan Q" first="Quamrul" last="Hassan">Quamrul Hassan</name><name sortKey="Yan, Andrew T" sort="Yan, Andrew T" uniqKey="Yan A" first="Andrew T." last="Yan">Andrew T. Yan</name></country><country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name></region><name sortKey="Kennelly, Brian" sort="Kennelly, Brian" uniqKey="Kennelly B" first="Brian" last="Kennelly">Brian Kennelly</name></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Lopez Sendon, Jose" sort="Lopez Sendon, Jose" uniqKey="Lopez Sendon J" first="Jose" last="Lopez-Sendon">Jose Lopez-Sendon</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name></region></country><country name="Pologne"><noRegion><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Steg, Ph Gabriel" sort="Steg, Ph Gabriel" uniqKey="Steg P" first="Ph. Gabriel" last="Steg">Ph. Gabriel Steg</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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