Quantitative ST-depression in acute coronary syndromes: the PLATO electrocardiographic substudy
Background - We evaluated whether electrocardiogram (ECG) characteristics were aligned with clinical outcomes and the effect of ticagrelor within the diverse spectrum of non-ST-elevation acute coronary syndrome patients enrolled in the PLATelet inhibition and patient Outcomes (PLATO) trial. - Method...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
21 June 2013
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| In: |
The American journal of medicine
Year: 2013, Volume: 126, Issue: 8, Pages: 723-729, 729.e1 |
| ISSN: | 1555-7162 |
| DOI: | 10.1016/j.amjmed.2013.01.038 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.amjmed.2013.01.038 Verlag, lizenzpflichtig, Volltext: http://www.sciencedirect.com/science/article/pii/S0002934313003951 
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| Author Notes: | Paul W. Armstrong, MD, Cynthia M. Westerhout, PhD, Yuling Fu, MD, Robert A. Harrington, MD, Robert F. Storey, MD, DM, Hugo Katus, MD, Stefan James, MD, PhD, Lars Wallentin, MD, PhD |
| Summary: | Background - We evaluated whether electrocardiogram (ECG) characteristics were aligned with clinical outcomes and the effect of ticagrelor within the diverse spectrum of non-ST-elevation acute coronary syndrome patients enrolled in the PLATelet inhibition and patient Outcomes (PLATO) trial. - Methods - There were 8884 PLATO patients who had baseline ECGs assessed by a core laboratory; of these, 4935 had an ECG at hospital discharge that also was assessed. Associations with study treatment on vascular death or myocardial infarction within 1 year were examined. - Results - At baseline, most patients had either no or ≤0.5 mm of ST-segment depression (57%); 26% had 1.0 mm, and 17% had more extensive depression (>1.0 mm). Across the baseline ST-segment depression strata, there was a consistent treatment benefit with ticagrelor versus clopidogrel on vascular death/myocardial infarction. The extent of residual ST-segment depression at discharge was similar in the treatment groups, and the treatment effect did not differ by the extent of discharge ST-segment depression. There was a progressive increase in vascular death/myocardial infarction with increasing extent of baseline ST-segment depression (1.0 mm [vs no/0.5 mm]: hazard ratio [HR] 1.22; 95% confidence interval [CI], 1.03-1.45; >1.0 mm: HR 1.49; 95% CI, 1.24-1.78; P <.001) and at discharge (HR 1.28; 95% CI, 1.02-1.61; HR 2.13; 95% CI, 1.54-2.95; P <.001). - Conclusion - The treatment effect of ticagrelor among non-ST-segment-elevation acute coronary syndrome patients was consistently expressed across all baseline ST-segment depression strata. There was no indication of an anti-ischemic benefit of ticagrelor as reflected on the discharge ECG. Our data affirm the independent prognostic relationship of both baseline and hospital discharge ST-segment depression on outcomes within 1 year in non-ST-segment-elevation acute coronary syndrome patients. |
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| Item Description: | Gesehen am 26.10.2020 |
| Physical Description: | Online Resource |
| ISSN: | 1555-7162 |
| DOI: | 10.1016/j.amjmed.2013.01.038 |