Admission Wall Motion Score and Quantitative ST-Segment Depression in the Assessment of 30-Day Mortality in Patients with First Non-ST-Segment Elevation Acute Coronary Syndromes

作者：Figueras Jaume^*; Barrabes Jose A; Evangelista Artur; Lidon Rosa Maria; Gutierrez Laura; Garcia del Blanco Bruno; Garcia Dorado David

来源：Journal of the American Society of Echocardiography, 2013, 26(8): 885-892.

DOI：10.1016/j.echo.2013.05.003

• Non-ST-segment elevation acute coronary syndromes
• Wall motion score
• Quantitative ST-segment depression
• Multivessel disease
• TIMI risk score

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. %26lt;br%26gt;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. %26lt;br%26gt;Results: Severity of WMS in quartiles was associated with peak troponin I (quartile 1, 5.2 mu g/L; quartile 2, 9.4 mu g/L; quartile 3, 11.7 mu g/L; quartile 4, 23.7 mu g/L; P%26lt;.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%26lt;.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%; %26lt;1.0 mm, 1.8%; 1.0-1.9 mm, 3.5%; 2.0-2.9 mm, 7.3%; %26gt;= 3.0 mm, 15.0%; P=.008). Mortality was also associated with age (P=.002), diabetes (P=.007), peripheral vascular disease (P%26lt;.001), Killip class %26gt;= II (P%26lt;.001), ejection fraction (P%26lt;.001), troponin I level (P%26lt;.001), three-vessel and/or left main coronary artery disease (P%26lt;.001), and admission TIMI risk score (P%26lt;.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%26lt;.001) or for TIMI score and Killip class %26gt; I (odds ratio per unit increase, 1.11; 95% confidence interval, 1.04-1.19; P=.004). %26lt;br%26gt;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.

• 出版日期2013-8