Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome
Center for Outcomes Research
Cardiology | Cardiovascular Diseases | Health Services Research
OBJECTIVE: To assess the relationship between the evolution of T wave inversion (TWI) on the 24-48 h postadmission ECG and the patient characteristics, management and clinical outcomes among those with non-ST elevation acute coronary syndrome (NSTE-ACS).
METHODS: We evaluated admission and 24-48 h follow-up ECGs of 7201 patients with NSTE-ACS from the prospective, multicentre Global Registry of Acute Coronary Events (GRACE) and Canadian ACS Registry I. We performed multivariable analyses to determine the association between new TWI (on follow-up ECG only), resolved TWI (on admission ECG only) and persistent TWI (on both admission and follow-up ECG) and inhospital and cumulative 6-month all-cause mortality.
RESULTS: Patients with TWI were older, more likely to have cardiovascular risk factors, higher Killip class and GRACE risk scores. After adjustment for known prognostic factors, compared with patients presenting without TWI, new TWI was associated with significantly lower inhospital mortality (OR=0.60, 95% CI 0.38 to 0.95, p=0.029), whereas resolved (OR=1.06, 95% CI 0.65 to 1.75, p=0.81) and persistent (OR=0.73, 95% CI 0.48 to 1.11, p=0.14) TWI did not predict inhospital mortality. No TWI pattern independently predicted inhospital adverse cardiovascular events or cumulative 6-month mortality. In contrast, ST depression on the admission and follow-up ECG were independent predictors of inhospital and 6-month mortality.
CONCLUSIONS: Across the spectrum of NSTE-ACS, TWI within 48 h of presentation was associated with high-risk clinical features, but its presence or dynamic change did not provide additional prognostic value beyond other established clinical predictors.
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Citation: Sarak B, Goodman SG, Yan RT, Tan MK, Steg PG, Tan NS, Fox KA, Udell JA, Brieger D, Welsh RC, Gale CP, Yan AT; Canadian Acute Coronary Syndromes I, and Global Registry of Acute Coronary Events (GRACE) Investigators. Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome. Heart. 2016 Sep 1;102(17):1396-402. doi: 10.1136/heartjnl-2015-309161. Epub 2016 Apr 25. PubMed PMID: 27112175. Link to article on publisher's site
Sarak, Bradley; Goodman, Shaun G.; Yan, Raymond T.; Tan, Mary K.; Steg, Phillippe Gabriel; Tan, Nigel S.; Fox, Keith A. A.; Udell, Jacob A.; Brieger, David; Welsh, Robert C.; Gale, Chris P.; Yan, Andrew T.; Canadian Acute Coronary Syndromes I; and Global Registry of Acute Coronary Events (GRACE) Investigators, "Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome" (2016). GRACE Publications. 124.