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Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome.
Heart. 2016 09 01; 102(17):1396-402.H

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.

Authors+Show Affiliations

St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada Canadian Heart Research Centre, Toronto, Canada.University of Toronto, Toronto, Canada.Canadian Heart Research Centre, Toronto, Canada.Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France.St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.Cardiovascular Division, Department of Medicine, Women's College Hospital and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada.Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.St Michael's Hospital, Toronto, Canada University of Toronto, Toronto, Canada.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

27112175

Citation

Sarak, Bradley, et al. "Prognostic Value of Dynamic Electrocardiographic T Wave Changes in non-ST Elevation Acute Coronary Syndrome." Heart (British Cardiac Society), vol. 102, no. 17, 2016, pp. 1396-402.
Sarak B, Goodman SG, Yan RT, et al. Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome. Heart. 2016;102(17):1396-402.
Sarak, B., Goodman, S. G., Yan, R. T., Tan, M. K., Steg, P. G., Tan, N. S., Fox, K. A., Udell, J. A., Brieger, D., Welsh, R. C., Gale, C. P., & Yan, A. T. (2016). Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome. Heart (British Cardiac Society), 102(17), 1396-402. https://doi.org/10.1136/heartjnl-2015-309161
Sarak B, et al. Prognostic Value of Dynamic Electrocardiographic T Wave Changes in non-ST Elevation Acute Coronary Syndrome. Heart. 2016 09 1;102(17):1396-402. PubMed PMID: 27112175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome. AU - Sarak,Bradley, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Tan,Mary K, AU - Steg,Ph Gabriel, AU - Tan,Nigel S, AU - Fox,Keith A A, AU - Udell,Jacob A, AU - Brieger,David, AU - Welsh,Robert C, AU - Gale,Chris P, AU - Yan,Andrew T, AU - ,, Y1 - 2016/04/25/ PY - 2015/12/10/received PY - 2016/03/24/accepted PY - 2016/4/27/entrez PY - 2016/4/27/pubmed PY - 2017/7/18/medline KW - ECG/electrocardiogram SP - 1396 EP - 402 JF - Heart (British Cardiac Society) JO - Heart VL - 102 IS - 17 N2 - 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. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/27112175/Prognostic_value_of_dynamic_electrocardiographic_T_wave_changes_in_non_ST_elevation_acute_coronary_syndrome_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=27112175 DB - PRIME DP - Unbound Medicine ER -