Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in
Nigel S Tan1, Shaun G Goodman, Raymond T Yan
1Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Insights
T-wave inversions (TWIs) in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) do not independently predict mortality. ST-segment depression (STD) remains a key predictor, and TWIs do not add prognostic value beyond existing risk models.
Area of Science:
- Cardiology
- Electrocardiography
- Acute Coronary Syndromes
Background:
- ST-segment depression (STD) predicts adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
- The prognostic value of T-wave inversions (TWIs) in NSTE-ACS is debated.
- Admission electrocardiograms are crucial for risk stratification.
Purpose of the Study:
- To determine the independent prognostic significance of T-wave inversions (TWIs) in NSTE-ACS.
- To assess if TWIs provide additional prognostic information beyond ST-segment depression (STD) and established risk factors.
- To evaluate the interaction between TWIs and STD for predicting adverse outcomes.
Main Methods:
- Analysis of 7,343 NSTE-ACS patient ECGs from GRACE and ACS I registries.
- Stratification of patients based on TWI and STD status.
- Multivariable analyses to assess independent predictors of in-hospital and 6-month mortality.
Main Results:
- Patients with TWI/STD had higher cardiovascular risk factors and Killip class.
- TWI did not independently predict in-hospital or 6-month mortality (aOR 1.03 and 1.02, respectively).
- STD remained a strong independent predictor; no interaction between TWI and STD was found.
Conclusions:
- T-wave inversion is associated with high-risk clinical features but not an independent predictor of mortality in NSTE-ACS.
- TWIs do not offer additional prognostication beyond the GRACE risk model.
- The prognostic value of STD is not altered by the presence of TWIs.
Background:
ST-segment depression (STD) is predictive of adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but there are conflicting data on the incremental prognostic value of T-wave inversions (TWIs) on the admission electrocardiogram.
Methods:
Admission electrocardiograms of 7,343 patients with NSTE-ACS from the Global Registry of Acute Coronary Events (GRACE) and ACS I registry were independently analyzed at a core laboratory and stratified by TWI and STD status. We performed multivariable analyses to determine the independent prognostic significance of TWI and tested for interaction between TWI and STD for adverse outcomes.
Results:
Patients with TWI and/or STD had a higher prevalence of cardiovascular risk factors, higher Killip class, and higher GRACE risk scores. Among the 2,708 patients with available angiographic data, rates of 3-vessel or left main disease were similar between patients with TWI and those without TWI/STD. After adjusting for other established prognosticators, TWI did not independently predict in-hospital (adjusted odds ratio 1.03, 95% CI 0.75-1.42, P = .85) or 6-month mortality (adjusted odds ratio 1.02, 95% CI 0.80-1.30, P = .88); STD remained a strong independent predictor. There was no interaction between TWI and STD for these outcomes. No contiguous lead groups or cumulative number of leads with TWI provided independent prognostic information.
Conclusions:
TWI is associated with other high-risk clinical features but is not an independent predictor of adverse short- and long-term mortality in NSTE-ACS. T-wave inversion does not provide additional prognostication beyond the GRACE risk model, and its concomitant presence does not alter the prognostic value of STD.
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