Prognostic value of the evolutive electrocardiographic changes in patients with non-ST elevation acute coronary syndromes: the ERICO-ECG study

Abstract

Acute coronary syndrome (ACS) is a frequent clinical condition. Survival after an ACS event has risen in the past years, due to therapeutic advances in the past decades. In Brazil, a significant proportion of ACS patients are treated in non-cardiologic, general health units. In this scenario, the recognition of prognostic determinants after an ACS event takes obvious importance, especially if they can be derived from elements present in non-specialized health services. There is evidence of the prognostic role of the electrocardiogram (ECG) obtained during the hospital admission in clinical prognosis of patients with ACS, but little is known about the impact of electrocardiographic changes that occur during the following in-hospital treatment. The existence of the strategy of registry of acute coronary syndrome study (ERICO study) at the Hospital Universitário da USP (HU-USP) creates a favorable, cost-effective scenario for this study. Objective: To study, among ERICO participants with unstable angina (UA) or acute myocardial infarction without ST-segment elevation (NSTEMI), the prognostic value of evolutionary electrocardiographic changes on the development of major cardiovascular events (reinfarction, coronary angioplasty, CABG or death) during the first 12 months of follow up. Methods: ERICO study is an ongoing prospective cohort of patients admitted with an ACS diagnosis in HU-USP since February 2009. Participants diagnosed with UA or NSTEMI, admitted from February 2009 to December 2012, will be included in the ancillary ERICO-ECG study. Two independent physicians will analyze ECG recordings, focusing on the presence of acute ischemic abnormalities. Initial and final ECG of the event will be coded according to the Minnesota Code. We estimate a sample of 501 individuals needed to detect a difference of 23% to 13% in the incidence of major cardiovascular events during the study period. (AU)