title: T-wave inversion on electrocardiogram is related to the risk of acute coronary syndrome in the general population.
abstract: BACKGROUND
  T-wave inversion (TWI) is a frequently encountered electrocardiographic (ECG) finding during routine medical examination of asymptomatic individuals, and of patients with various clinical conditions. However, the role of isolated TWI in the prediction of acute coronary syndrome (ACS) in the community has not been extensively studied. We investigated the relationship between TWI in routine ECG and the risk for ACS in the general population.
  
  
  METHODS
  This study is based on a random sample of 1997 men aged 42-60 years in Eastern Finland. Electrocardiograms recorded at rest were classified using the Minnesota codes. The association between isolated TWI and ACS was determined using a multivariable adjusted Cox proportional hazard model.
  
  
  RESULTS
  Negative T-waves were present in 3.6% of the participants. During an average follow-up of 20 years, a total of 493 ACS events were registered. After adjusting for age, TWI was associated with a 3.10-fold (95% confidence interval (CI) 2.21-4.32) risk for ACS. After additional adjustment for previously known coronary risk factors, TWI remained statistically significant in predicting ACS (relative risk 2.23; 95% CI 1.57-3.15). Negative T-waves was one of the strongest risk markers for ACS compared with other ECG-based variables such as left ventricular hypertrophy, previous Q-wave and prolonged QRS duration.
  
  
  CONCLUSIONS
  TWI has a strong and independent predictive value for ACS in the general population.
authors.affiliation: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Finland.
authors.forename: Victor N
authors.initials: VN
authors.lastname: Bakhoya
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D000328:Adult; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005387:Finland / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors