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Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes.
Am Heart J. 2013 Aug; 166(2):290-7.AH

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+Show Affiliations

Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23895812

Citation

Tan, Nigel S., et al. "Comparative Prognostic Value of T-wave Inversion and ST-segment Depression On the Admission Electrocardiogram in non-ST-segment Elevation Acute Coronary Syndromes." American Heart Journal, vol. 166, no. 2, 2013, pp. 290-7.
Tan NS, Goodman SG, Yan RT, et al. Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes. Am Heart J. 2013;166(2):290-7.
Tan, N. S., Goodman, S. G., Yan, R. T., Elbarouni, B., Budaj, A., Fox, K. A., Gore, J. M., Brieger, D., López-Sendón, J., Langer, A., van de Werf, F., Steg, P. G., & Yan, A. T. (2013). Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes. American Heart Journal, 166(2), 290-7. https://doi.org/10.1016/j.ahj.2013.04.010
Tan NS, et al. Comparative Prognostic Value of T-wave Inversion and ST-segment Depression On the Admission Electrocardiogram in non-ST-segment Elevation Acute Coronary Syndromes. Am Heart J. 2013;166(2):290-7. PubMed PMID: 23895812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non-ST-segment elevation acute coronary syndromes. AU - Tan,Nigel S, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Elbarouni,Basem, AU - Budaj,Andrzej, AU - Fox,Keith A A, AU - Gore,Joel M, AU - Brieger,David, AU - López-Sendón,Jose, AU - Langer,Anatoly, AU - van de Werf,Frans, AU - Steg,Ph Gabriel, AU - Yan,Andrew T, Y1 - 2013/05/23/ PY - 2013/03/06/received PY - 2013/04/17/accepted PY - 2013/7/31/entrez PY - 2013/7/31/pubmed PY - 2013/10/18/medline SP - 290 EP - 7 JF - American heart journal JO - Am. Heart J. VL - 166 IS - 2 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/23895812/Comparative_prognostic_value_of_T_wave_inversion_and_ST_segment_depression_on_the_admission_electrocardiogram_in_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(13)00299-8 DB - PRIME DP - Unbound Medicine ER -