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Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome
  1. Bradley Sarak1,2,
  2. Shaun G Goodman1,2,3,
  3. Raymond T Yan2,
  4. Mary K Tan3,
  5. Ph. Gabriel Steg4,
  6. Nigel S Tan1,2,
  7. Keith A A Fox5,
  8. Jacob A Udell6,
  9. David Brieger7,
  10. Robert C Welsh8,
  11. Chris P Gale9,
  12. Andrew T Yan1,2
  13. for the Canadian Acute Coronary Syndromes I, and Global Registry of Acute Coronary Events (GRACE) Investigators
  1. 1St Michael's Hospital, Toronto, Canada
  2. 2University of Toronto, Toronto, Canada
  3. 3Canadian Heart Research Centre, Toronto, Canada
  4. 4Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France
  5. 5Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  6. 6Cardiovascular Division, Department of Medicine, Women's College Hospital and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
  8. 8Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada
  9. 9Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Dr Andrew T Yan, St Michael's Hospital, Division of Cardiology, 30 Bond Street, Rm 6-030 Donnelly, Toronto, Ontario, Canada M5B 1W8; yana{at}


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.

  • ECG/electrocardiogram

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