- 作者：Jaume Figueras ; Jos¨¦ A. Barrab¨¦s ; Artur Evangelista ; Rosa-Maria Lid¨®n ; Laura Gutierrez ; Bruno Garcia del Blanco ; David Garcia-Dorado
- 关键词：Non&ndash ; ST-segment elevation acute coronary syndromes ; Wall motion score ; Quantitative ST-segment depression ; Multivessel disease ; TIMI risk score
- 刊名：Journal of the American Society of Echocardiography
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：26
- 期：8
- 页码：885-892
- 全文大小：700 K
Background
Whether admission myocardial wall motion score (WMS) in non-ST-segment elevation acute coronary syndromes might be a better predictor of 30-day mortality than currently recognized prognostic markers is unknown.Methods
Admission echocardiographic and electrocardiographic data as well as coronary angiographic data were prospectively evaluated in 488 patients. Variables analyzed were clinical data, quantitative ST-segment depression, peak troponin I, WMS, ejection fraction, extent of coronary artery disease, and Thrombolysis In Myocardial Infarction (TIMI) risk score.
Results
Severity of WMS in quartiles was associated with peak troponin I (quartile 1, 5.2 ¦Ìg/L; quartile 2, 9.4 ¦Ìg/L; quartile 3, 11.7 ¦Ìg/L; quartile 4, 23.7 ¦Ìg/L; P < .001) and with the sum of all leads with ST-segment depression (quartile 1, ?2.5 mm; quartile 2, ?3.2 mm; quartile 3, ?3.8 mm; quartile 4, ?5.1 mm; P < .001). Thirty-day mortality was associated with increased worsening of WMS (quartiles 1, 0.7 % ; quartile 2, 3.4 % ; quartile 3, 3.8 % ; quartile 4, 11.5 % ; P?= .001) and quantitative ST-segment depression (0 mm, 2.7 % ; <1.0 mm, 1.8 % ; 1.0-1.9 mm, 3.5 % ; 2.0-2.9 mm, 7.3 % ; ¡Ý3.0 mm, 15.0 % ; P?= .008). Mortality was also associated with age (P?= .002), diabetes (P?= .007), peripheral vascular disease (P < .001), Killip class ¡Ý II (P < .001), ejection fraction (P < .001), troponin I level (P < .001), three-vessel and/or left main coronary artery disease (P < .001), and admission TIMI risk score (P < .001). Nevertheless, WMS predicted 30-day mortality after adjusting for TIMI risk score (odds ratio per unit increase, 1.14; 95 % confidence interval, 1.06-1.21; P?<?.001) or for TIMI score and Killip class > I (odds ratio per unit increase, 1.11; 95 % confidence interval, 1.04-1.19; P?= .004).
Conclusions
In comparison with quantitative ST-segment depression, troponin I, and TIMI risk score, WMS on admission is a better early predictor of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.