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

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    Authors
    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
    Global Registry of Acute Coronary Events (GRACE) Investigators
    Show allShow less
    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2016-09-01
    Keywords
    Cardiology
    Cardiovascular Diseases
    Health Services Research
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1136/heartjnl-2015-309161
    Abstract
    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.
    Source
    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
    DOI
    10.1136/heartjnl-2015-309161
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27196
    PubMed ID
    27112175
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1136/heartjnl-2015-309161
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