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ST-segmen depression as a strongest predictor of three-vessel disease in patients non-ST-segment elevation acute coronary syndromes with Diabetes Mellitus

Author : M. Nasri, Z. Safri, C. A. Andra, H. Hasan, Z. Mukhtar, A. H. Raynaldo
Upload Date : 19-04-2018

Background: Electrocardiogram (ECG) is a simple, non-invasive modality widely used for diagnostic and prognostic tools in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Early identification of  three-vessel disease (3-VD) in ECG findings in NSTE-ACS with diabetes mellitus (DM) patients is important, due to consideration of prognosis and revascularization modalities. Previous studies that compare 3-VD incidence based on ST-segment-depression were not specified for NSTE-ACS with DM patients. Especially with our current national insurance system, it can be a guide for healthcare providers in terms of management strategies so that NSTE-ACS with DM patients get optimal management and revascularization. The objective of this study was to assess the predictive value of  ST-segment depression for the incidence of 3-VD in NSTE-ACS with DM patients.

Methods: 67 NSTE-ACS with DM patients that hospitalized from January 2015-December 2017 in Rumah Sakit Umum Pusat Haji Adam Malik were analyzed retrospectively. Patients were divided into two group based on ST-segment depression on admission ECG. Bivariate and multivariate analysis were performed to study association between ST-segmen depression and 3-VD, p value < 0.05 was considered statistically significant.

Results: Bivariate analysis shows that 3-VD incidence was higher in NSTE-ACS with DM patient accompanied by ST depression compared to without ST depression (80.6% vs 19.4 %, p <0.001). On multiple  logistic regression analysis, patients with ST-segment depression  had a 27.3 fold increased risk for 3-VD [OR  27.3 (6.117 – 121.851), p=0.000].

Conclusion: The presence of ST segment depression on admission ECG in NSTE-ACS with DM patients was associated with a higher incidence of 3-VD and was the strongest independent predictor of 3-VD. In clinical practice, it may serves as a simple non-invasive tool for predicting 3-VD in NSTE-ACS with DM patients.

KEYWORDS : ST-segment depression, NSTE-ACS, DM, 3-VD

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