title: Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  ST-segment depression (STD) is predictive of adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but there are conflicting data on the incremental prognostic value of T-wave inversions (TWIs) on the admission electrocardiogram.
  
  
  METHODS
  Admission electrocardiograms of 7,343 patients with NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and ACS I registry were independently analyzed at a core laboratory and stratified by TWI and STD status. We performed multivariable analyses to determine the independent prognostic significance of TWI and tested for interaction between TWI and STD for adverse outcomes.
  
  
  RESULTS
  Patients with TWI and/or STD had a higher prevalence of cardiovascular risk factors, higher Killip class, and higher GRACE risk scores. Among the 2,708 patients with available angiographic data, rates of 3-vessel or left main disease were similar between patients with TWI and those without TWI/STD. After adjusting for other established prognosticators, TWI did not independently predict in-hospital (adjusted odds ratio 1.03, 95% CI 0.75-1.42, P = .85) or 6-month mortality (adjusted odds ratio 1.02, 95% CI 0.80-1.30, P = .88); STD remained a strong independent predictor. There was no interaction between TWI and STD for these outcomes. No contiguous lead groups or cumulative number of leads with TWI provided independent prognostic information.
  
  
  CONCLUSIONS
  TWI is associated with other high-risk clinical features but is not an independent predictor of adverse short- and long-term mortality in NSTE-ACS. T-wave inversion does not provide additional prognostication beyond the GRACE risk model, and its concomitant presence does not alter the prognostic value of STD.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Tan
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.forename: Basem
authors.initials: B
authors.lastname: Elbarouni
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.forename: Jose
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Frans
authors.initials: F
authors.lastname: van de Werf
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011379:Prognosis