Anatomic and prognostic significance of new T-wave inversion in unstable angina

The significance of the development of new T-wave inversion was studied in 118 consecutive patients with unstable angina. The electrocardiograms during hospitalization in the coronary care unit were analyzed for occurrence of new T-wave inversion greater than or equal to 2 mm and correlated with findings at coronary angiography (73 patients) and at follow-up (112 patients). Twenty-nine patients had anterior T-wave inversion. Of these, 25 patients (86%) had greater than or equal to 70% diameter reduction of the left anterior descending (LAD) artery, compared with 11 (26%) of 42 patients without anterior T-wave inversion (p less than 0.001). The sensitivity of T-wave inversion for significant LAD stenosis was 69%, specificity 89%, and positive predictive value 86%. Two patients had T-wave inversion in the inferior leads. Both patients had significant right coronary artery disease, compared with 18 of 55 patients without inferior T-wave inversion (difference not significant [p = NS]. Seventy-one patients who were treated medically had 16 +/- 9 months' follow-up. Of 26 patients who had T-wave inversion, 10 (38%) had cardiac events, compared with 7 (16%) of the remaining 45 patients without T-wave inversion (p less than 0.05). Forty-one patients who had undergone coronary bypass surgery had 19 +/- 9 months' follow-up. Of 22 patients with T-wave inversion, 4 (18%) had cardiac events, compared with 2 (11%) of the remaining 19 patients without T-wave inversion (p = NS). Thus, development of new T-wave inversion greater than or equal to 2 mm in patients with unstable angina (1) is predictive of significant coronary artery stenosis, and (2) identifies a subgroup with poor prognosis when treated medically.