Patient selection - chest pain within previous 48 hours with one or more of the following:
(1) elevation of cardiac markers (troponin)
(2) ST depression
(3) T wave inversion
Exclusion: ST-segment elevation
Outcome events: acute myocardial infarction and/or death within 1 year
Invasive treatment strategy:
(1) percutaneous coronary intervention (PCI) with 1 or 2 target lesions, not involving the left main coronary artery
(2) CABG if 3 vessel disease or involvement of the left main coronary artery
Parameters:
(1) presence of confounding factor that precludes ECG analysis
(2) total sum of ST segment deviation (absolute value of depression) in 11 leads (standard 12 leads except aVR)
(3) number of the same 11 leads with individual deviation >= 0.5 mm
Confounding factors (from Appendix A):
(1) left and/or right bundle branch block
(2) left anterior and/or posterior hemiblock
(3) left and/or right ventricular hypertrophy
(4) Wolf-Parkinson-White syndrome
Patients with a confounding factor:
(1) did about the same with either an invasive or noninvasive treatment strategy
(2) tended to have worse outcomes than patients without the confounding factors
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Patients Who Benefit from an Invasive Management Strategy
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Findings
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total sum of deviations
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> 2.5 mm
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number of leads >= 0.5 mm
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>= 5 leads
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