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

Sarak, Bradley; Goodman, Shaun G.; Yan, Raymond T.; Tan, Mary; Steg, Philippe Gabriel; Tan, Nigel S.; Fox, Keith; Udell, Jacob A.; Brieger, David; Welsh, Robert C.; Gale, Chris P; Yan, Andrew T.

doi:10.1136/heartjnl-2015-309161

Cited by 12 publications

(19 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although evidence supports T‐wave abnormality's adverse prognostic significance,4, 20, 21 our data for the first time indicate that myocardial edema may be the substrate for T‐wave abnormality.…”

Section: Discussionmentioning

confidence: 55%

“…A recent ECG substudy of GRACE (the Global Registry of Acute Coronary Events) and ACS Registry I (the Canadian Acute Coronary Syndromes ACS Registry I) involving more than 7000 patients with NSTE‐ACS showed that the presence versus absence of T‐wave abnormalities, at presentation ECG, portended significantly higher in‐hospital and 6‐month mortality risk 4. Although that study highlights the clinical importance of abnormal T waves in the context of NSTE‐ACS, it does not elucidate its pathophysiologic mechanism.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…STD on the admission ECG is well known to indicate a poor prognosis in patients with suspected AMI [ 4 , 5 , 6 , 8 , 9 , 10 , 11 , 18 ]. Also, previous studies which have investigated the possible prognostic impact of dynamic ST-segment changes during follow-up or on the discharge ECG revealed mixed results [ 19 , 20 , 21 , 22 , 23 ]. The inclusion criteria of the cited studies partly differ substantially but can roughly be categorized in two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies have investigated the prognostic value of follow-up or discharge ECGs and showed that additional information can be derived from these ECGs [ 20 , 23 ]. Not all studies showed additional information for risk stratification and outcome besides those derived from admission ECG [ 19 , 21 ]. All the mentioned studies used different timepoints for documentation of the second ECG (at least 12 h after admission) [ 19 , 20 , 21 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Not all studies showed additional information for risk stratification and outcome besides those derived from admission ECG [ 19 , 21 ]. All the mentioned studies used different timepoints for documentation of the second ECG (at least 12 h after admission) [ 19 , 20 , 21 , 23 ]. Little is known about possible prognostic value of short-term serial ECGs in the emergency department in the first hours after presentation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Lehmacher¹,

Neumann

Sörensen

et al. 2020

JCM

View full text Add to dashboard Cite

The electrocardiogram (ECG) is an important diagnostic tool for patients with suspected acute myocardial infarction (AMI). Current guidelines recommend serial ECGs in case of persisting symptoms. We aimed to analyze the predictive value of ischemic ECG-signs in patients with suspected AMI. Patients presenting to the emergency department with suspected AMI were included. All patients with ST-elevation AMI were excluded from analyses. Patients received 12-lead-ECG and high-sensitive Troponin T (hs-TnT)-measurement at admission and after 3 h. Four groups were defined: no ischemic signs in either ECG; new ischemic signs in the second ECG; resolved ischemic signs in the second ECG; and persistent ischemic signs in both ECGs. Patients were followed for 2 years to assess the composite endpoint of all-cause-mortality, AMI, and coronary revascularization. Using a 30-day landmark analysis, a Cox regression with ischemic signs as the variable of interest, adjusted by cardiovascular risk factors, was calculated. Of 1675 patients, 1321 showed no ischemic signs, in 25 new-, in 92 resolved- and in 237 patients, persistent ischemic signs were documented. Patients with persistent ischemic signs had significantly worse outcomes, compared to those without. Compared to no ischemic signs, adjusted hazard ratios for the combined endpoint were 0.81 (95% CI 0.20, 3.31; p-value = 0.77) for new-, 0.59 (95% CI 0.26, 1.34; p-value = 0.21) for resolved-, and 1.47 (95% CI 1.102, 2.13; p-value = 0.041) for persistent ischemic signs. In patients with suspected AMI, persistent ischemic ECG-signs are predictive of a higher rate of all-cause-mortality, AMI, and revascularization.

show abstract

Prognostic value of admission electrocardiographic findings in non‐ST‐segment elevation myocardial infarction

Chen

Tang

Pei

et al. 2020

Clinical Cardiology

View full text Add to dashboard Cite

BackgroundAdmission electrocardiographic (ECG) findings of non‐ST‐segment elevation myocardial infarction (NSTEMI) include transient ST‐segment elevation (TSTE), ST‐segment depression (STD), T‐wave inversion (TWI), and no ischemic changes (NIC).HypothesisThis study aimed to assess the prognostic value of qualitative ECG findings at presentation and to clarify the influence of invasive treatment on the prognostic value of admission ECG findings.MethodsWe analyzed the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) study post hoc. NSTEMI patients were included and classified into four groups per ECG findings. Study endpoints were in‐hospital and 30‐day mortality rates and major adverse events (MAE). We performed multivariate logistic regression, adjusting for covariates in the Global Registry of Acute Coronary Events risk model, with subset analyses of patients treated with or without invasive management.ResultsSTD patients had significantly higher in‐hospital and 30‐day mortality rates/MAE than TWI patients, which had lower in‐hospital mortality rate/MAE than the NIC group. TSTE patients had intermediate outcomes. In multivariate logistic regression using the TWI group as the reference, STD and NIC remained independently associated with worse outcomes. Subset analysis showed prognostic value of admission ECG in non‐invasively managed but not in invasively managed patients.ConclusionsSTD was associated with adverse outcomes, TWI with benign prognoses. NIC should not be taken to indicate low risk. Qualitative analysis of admission ECG is suitable for rapid risk stratification of NSTMI patients at presentation. However, it may not be predictive of short‐term outcomes of NSTEMI patients after invasive management.

show abstract

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

Abstract: 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.

Cited by 12 publications

References 36 publications

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Predictive Value of Serial ECGs in Patients with Suspected Myocardial Infarction

Prognostic value of admission electrocardiographic findings in non‐ST‐segment elevation myocardial infarction

Contact Info

Product

Resources

About