Savonitto et al identified short term prognosis for patients with acute coronary syndromes based on the admission electrocardiogram and serum creatine kinase concentration. This can help identify patients at risk for death or reinfarction. Elevation of the serum creatine kinase (CK) concentration on admission is associated with a worse prognosis. The authors are from 10 hospitals in Europe and the United States, with the lead author from Ospedale Niguarda Ca Granda in Milan.
Parameters:
(1) changes seen on the admission ECG
(1a) isolated T wave inversion
(1b) ST segment elevation
(1c) ST segment depression
(1d) both ST segment elevation and depression
(2) serum creatine kinase (CK)
|
Odds Ratio for Death in 30 Days
|
CK Not "Elevated"
|
CK "Elevated"
|
CK Unknown
|
|
T inversion only
|
1.7
|
1.8
|
1.7
|
|
ST segment elevation
|
4.5
|
8.7
|
5.1
|
|
ST segment depression
|
4.3
|
11.3
|
5.1
|
|
ST segment elevation and depression
|
5.7
|
14.4
|
6.6
|
from Tables 3 and 4, page 710-711 (see tables for 95% CI)
|
Odds Ratio for Death by 6 Months
|
CK Not "Elevated"
|
CK "Elevated"
|
CK Unknown
|
|
T inversion only
|
3.5
|
3.2
|
3.4
|
|
ST segment elevation
|
6.0
|
11.2
|
6.8
|
|
ST segment depression
|
8.0
|
14.8
|
8.9
|
|
ST segment elevation and depression
|
8.5
|
15.4
|
9.1
|
from Tables 3 and 4, page 710-711 (see tables for 95% CI)
|
Odds Ratio for 30 Day Death or Reinfarction
|
CK Not "Elevated"
|
CK "Elevated"
|
CK Unknown
|
|
T inversion only
|
5.6
|
5.3
|
5.5
|
|
ST segment elevation
|
8.6
|
13.2
|
9.4
|
|
ST segment depression
|
9.7
|
16.7
|
10.5
|
|
ST segment elevation and depression
|
11.9
|
16.4
|
12.4
|
from Tables 3 and 4, page 710-711 (see tables for 95% CI)
|
Odds Ratio for 6 Month Death or Reinfarction
|
CK Not "Elevated"
|
CK "Elevated"
|
CK Unknown
|
|
T inversion only
|
8.3
|
8.0
|
8.1
|
|
ST segment elevation
|
11.4
|
16.4
|
12.3
|
|
ST segment depression
|
14.6
|
21.7
|
15.4
|
|
ST segment elevation and depression
|
15.6
|
18.7
|
15.7
|
from Tables 3 and 4, page 710-711 (see tables for 95% CI)
where:
• The CK is considered "elevated" when it is greater than 2 times the upper limit of normal for the laboratory.
• It would be interesting to see the data using troponin levels.
