Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome.
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).



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.



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.



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.
St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.
Bradley
B
Sarak
St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada Canadian Heart Research Centre, Toronto, Canada.
Shaun G
SG
Goodman
University of Toronto, Toronto, Canada.
Raymond T
RT
Yan
Canadian Heart Research Centre, Toronto, Canada.
Mary K
MK
Tan
Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France.
Ph Gabriel
PG
Steg
St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.
Nigel S
NS
Tan
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Keith A A
KA
Fox
Cardiovascular Division, Department of Medicine, Women's College Hospital and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Jacob A
JA
Udell
Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
David
D
Brieger
Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada.
Robert C
RC
Welsh
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Chris P
CP
Gale
St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.
Andrew T
AT
Yan
D000200:Action Potentials; D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
ECG/electrocardiogram