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

J Am Soc Echocardiogr. 2013 Aug;26(8):885-92. doi: 10.1016/j.echo.2013.05.003. Epub 2013 Jun 19.

Abstract

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 μg/L; quartile 2, 9.4 μg/L; quartile 3, 11.7 μg/L; quartile 4, 23.7 μg/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%; ≥3.0 mm, 15.0%; P = .008). Mortality was also associated with age (P = .002), diabetes (P = .007), peripheral vascular disease (P < .001), Killip class ≥ 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.

Keywords: CABG; CI; CK-MB; Confidence interval; Coronary artery bypass grafting; Creatine kinase–MB; ECG; Electrocardiographic; Multivessel disease; NSTEACS; Non–ST-segment elevation acute coronary syndromes; Quantitative ST-segment depression; TIMI; TIMI risk score; Thrombolysis In Myocardial Infarction; TnI; Troponin I; WMS; Wall motion score.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / mortality*
  • Aged
  • Comorbidity
  • Echocardiography / statistics & numerical data
  • Female
  • Hospital Mortality*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Patient Admission / statistics & numerical data*
  • Prevalence
  • Prognosis
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Spain / epidemiology
  • Survival Analysis
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / mortality*