Quantitative T-wave analysis predicts 1 year prognosis and benefit from early invasive treatment in the FRISC II
Michael D Jacobsen1, Galen S Wagner, Lene Holmvang
1The Heart Center, Department of Medicine B, H:S Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. mdiloujacobsen@dadlnet.dk
Insights
New T-wave analysis on ECGs can predict outcomes for patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). This method also identifies NSTE-ACS patients who benefit from early coronary angiography.
Area of Science:
- Cardiology
- Electrocardiography
- Acute Coronary Syndromes
Background:
- T-wave abnormalities are common in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) but their prognostic value is underutilized.
- Quantitative analysis of T-wave changes may offer improved prognostic insights compared to traditional ECG interpretations.
Purpose of the Study:
- To evaluate the prognostic significance of T-wave abnormalities in NSTE-ACS patients.
- To determine if specific T-wave patterns predict benefit from early coronary angiography in NSTE-ACS.
Main Methods:
- Quantitative T-wave analysis was applied to admission ECGs of 1609 NSTE-ACS patients.
- Prognostic value for clinical outcomes was assessed for nine T-wave abnormality categories in patients not undergoing early angiography.
- Predictive value for early angiography benefit was analyzed for T-wave abnormalities across multiple ECG leads.
Main Results:
- Patients with T-wave abnormalities in >=6 leads and ST-segment depression faced higher risks without early angiography (24% vs 12%), a risk mitigated by the procedure.
- Five T-wave abnormality categories were significantly linked to adverse outcomes in non-invasively treated patients.
- Early angiography significantly reduced adverse events in high-risk NSTE-ACS patients identified by T-wave analysis.
Conclusions:
- Quantitative T-wave analysis of admission ECGs provides valuable prognostic information in NSTE-ACS.
- This ECG analysis method effectively identifies NSTE-ACS patients who are likely to benefit from early coronary angiography.
Aims:
To investigate the prognostic value of T-wave abnormalities in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and whether such ECG changes may predict benefit from an early coronary angiography. Although ST-segment changes are considered the most important ECG feature in NSTE-ACS, T-wave abnormalities are the most common ECG finding. We hypothesize that a new quantitative approach to T-wave analysis could improve the prognostic value of this ECG abnormality.
Methods And Results:
Quantitative T-wave analysis was performed on the admission ECG in 1609 patients with NSTE-ACS. Nine different categories of T-wave abnormality were analysed for their prognostic value concerning clinical outcome in patients not randomized to early coronary angiography. Also, the presence of one category (i.e. T-wave abnormality in > or =6 leads) was analysed for its predictive value concerning benefit from early coronary angiography. The combined study endpoint was death or myocardial infarction at 1 year follow-up. Patients with > or =6 leads with abnormal T-waves and concomitant ST-segment depression had a higher risk when not receiving early coronary angiography (24 vs. 12%, respectively; P=0.003), but could be brought to the same level of risk as the remaining patients with this treatment. For non-invasively treated patients five different categories of T-wave abnormality were significantly associated with an adverse outcome.
Conclusion:
New quantitative T-wave analysis of the admission ECG gives additional predictive information concerning clinical outcome and identifies patients who benefit from early coronary angiography.
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