12-lead Electrocardiogram in Acute Coronary Syndrome (Pehmeäkantinen kirja)

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Based on randomized clinical trials, the mortality of acute coronary syndrome (ACS) has been regarded as relatively low. However, the prognosis of clinical presentations of ACS in unselected "real-life" patient cohorts has not been well-documented. The significance of the electrocardiogram (ECG) ST-segment depression in ACS has been the subject for debate for many decades. Studies indicate that various manifestations of ST/T changes may have significantly different prognostic implications. Widespread ST-segment depression in combination with lead aVR ST-segment elevation is a marker of an adverse outcome in patients with non-ST-elevation (NSTE-) ACS -- perhaps because this pattern is indicative of severe coronary artery disease (CAD), including left main coronary artery (LM) stenosis. However, the prognostic value of this circumferential subendocardial ischemia (CSI) ECG pattern has not yet been established.

The aims of the present study were to investigate the significance of ST-segment depression and T-wave changes in ACS, with respect to in-hospital prognosis, troponin levels and angiographic findings (I); evaluate the prognostic significance of the three different clinical entities of ACS in prospectively collected consecutive patients from a university hospital (II); study the distribution of various ECG patterns on admission in patients with ACS and define the prognostic value of these pre-defined ECG patterns (III); compare preoperative 12-lead ECG findings during anginal pain in patients with as well as without LM disease who underwent isolated urgent or emergent bypass surgery; and, finally, study the sensitivity, specificity and predictive values for the CSI ECG pattern to predict angiographic LM disease (IV).
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