Rev Esp Cardiol. 2010;63(7):851-5 851 In-Hospital Prognosis in Non-ST-Segment Elevation Acute Coronary Syndrome Derived Using a New Risk Score Based on Electrocardiographic Parameters Obtained at Admission Javier Jiménez-Candil, José Manuel González Matas, Ignacio Cruz González, Jesús Hernández Hernández, Ana Martín, Pedro Pabón, Francisco Martín, and Cándido Martín-Luengo Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain BRIEF REPORT Correspondence: Dr. J. Jiménez-Candil. Hospital Universitario de Salamanca. P. o de San Vicente, 58-182. 37007 Salamanca. Spain. E-mail: jimenezcandil@secardiologia.es Received January 7, 2009. Accepted for publication July 23, 2009. Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) ≥450 ms (odds ratio 4.2, P<.001), ST-segment depression >0.5 mm (odds ratio 2.7, P<.001), and left atrial enlargement (odds ratio 1.8, P=.005). After taking the odds ratios into consideration, we awarded 3 points for a QTc ≥450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. ≤1, 2–3 and ≥4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P<.001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS. Key words: Acute coronary syndrome. Electrocardiogram. Prognosis. Pronóstico hospitalario del síndrome coronario agudo sin elevación del segmento ST determinado por una nueva escala de riesgo integrada por variables electrocardiográficas obtenidas al ingreso Diferentes variables electrocardiográficas tienen ca- pacidad predictiva en el síndrome coronario agudo sin elevación del ST (SCASEST). Tras analizar a 427 pacien- tes, construimos una escala de riesgo (ER) basada en el ECG al ingreso (ER-ECG) para definir la probabilidad de muerte o isquemia recurrente (M-IsqR) durante la hospi- talización, que fue del 36%. En un análisis de regresión logística que incluyó siete variables electrocardiográficas y las de la ER TIMI, alcanzaron la significación estadísti- ca: QTc ≥ 450 ms (odds ratio [OR] = 4,2; p < 0,001); des- censo del ST > 0,5 (OR = 2,7; p < 0,001) y crecimiento auricular izquierdo (OR = 1,8; p = 0,005). En función de la OR, se otorgó 3 puntos a QTc ≥ 450 ms, 2 a descenso del ST > 0,5 mm y 1 a crecimiento auricular izquierdo. Agrupando a los pacientes según la ER-ECG en: ≤ 1, 2-3, ≥ 4, ésta discriminó adecuadamente la probabilidad de M-IsqR: el 11 frente al 27 frente al 58% (p < 0,001). Por lo tanto, esta ER-ECG permite estratificar el pronóstico del SCASEST de una forma simple, rápida y precisa. Palabras clave: Síndrome coronario agudo. Electrocar- diograma. Pronóstico. IINTRODUCTION Patients attended for non-ST segment elevation acute coronary syndrome (NSTEACS) constitute a wide-ranging clinical population. If prognostic stratification of these patients were rapid (ideally on admission) and simple, efficacy and efficiency would improve because we could easily identify higher-risk patients who might benefit from more costly, more aggressive medical and interventional therapies. To this extent, several risk scores (RS) for NSTEACS have been described. 1,2 However, most of these are limited in that some of the variables on which they are based are not obtained immediately “at the patient’s bedside” because they are either analytical or data-based variables that are not always obvious from the patient’s clinical record. Document downloaded from https://www.revespcardiol.org/, day 14/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 14/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.