Hyperacute T Waves Are Specific for Occlusion Myocardial Infarction, Even Without Diagnostic ST-Segment Elevation

Area of Science:

• Cardiology
• Electrocardiography
• Emergency Medicine

Background:

• Hyperacute T waves (HATW) are clinically recognized but lack an objective definition.
• The American College of Cardiology recommends HATW as a STEMI equivalent, necessitating urgent reperfusion.

Purpose of the Study:

• To derive and validate a quantitative definition for hyperacute T waves (HATW).
• To assess the clinical utility of a novel HATW score in identifying acute coronary occlusion.

Main Methods:

• Retrospective analysis of adults with suspected acute coronary syndrome (ACS) across five PCI centers.
• ECG measures included T wave magnitude and symmetry; HATW score derived and validated on separate patient cohorts.
• Primary analysis focused on HATW score performance for acute coronary occlusion in patients lacking STEMI criteria.

Main Results:

• The derived HATW score threshold (≥ 0.7 in 2 leads) achieved ≥ 98% specificity.
• In validation, the HATW score showed 98.4% specificity for acute coronary occlusion in patients without STEMI criteria.
• Among these patients, 84% with a positive HATW score had an acute myocardial infarction (AMI) culprit lesion.

Conclusions:

• The HATW score provides the first objective definition for hyperacute T waves.
• This score demonstrates significant clinical utility for detecting acute coronary occlusion in potential ACS patients.