TY - JOUR T1 - Prognostic value of dynamic electrocardiographic T wave changes in non-ST elevation acute coronary syndrome JF - Heart JO - Heart SP - 1396 LP - 1402 DO - 10.1136/heartjnl-2015-309161 VL - 102 IS - 17 AU - Bradley Sarak AU - Shaun G Goodman AU - Raymond T Yan AU - Mary K Tan AU - Ph. Gabriel Steg AU - Nigel S Tan AU - Keith A A Fox AU - Jacob A Udell AU - David Brieger AU - Robert C Welsh AU - Chris P Gale AU - Andrew T Yan Y1 - 2016/09/01 UR - http://heart.bmj.com/content/102/17/1396.abstract 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. ER -