Clinical significance of abnormal T waves in patients with non-ST-segment elevation acute coronary syndromes

Am J Cardiol. 2001 Dec 1;88(11):1225-9. doi: 10.1016/s0002-9149(01)02081-1.

Abstract

T-wave abnormalities are common electrocardiographic occurrences in patients with non-ST-segment elevation acute coronary syndromes. Although these abnormalities are considered relatively benign, physicians use them to guide therapies. The study objective was to examine the prognostic predictive information of T-wave abnormalities in the setting of unstable coronary artery disease. The T-wave abnormality criterion was based on a new set of normal T-wave amplitude limits differentiated by gender, age, electrocardiographic lead, and QRS axis. Four hundred sixty-eight patients suspected of an acute ischemic incident and considered ineligible for reperfusion therapy were included. Thirteen categories of T-wave abnormalities were tested prospectively. The primary 30-day end point was the combination of refractory angina, myocardial infarction, or death. Quantitative T-wave analysis in an electrocardiographic core laboratory revealed 6 of 13 prespecified categories of T-wave abnormalities that were significantly associated with an adverse outcome. T-wave abnormalities had no prognostic value when ST-segment depression was also present, but this occurred in only 7.9% of patients. T-wave abnormalities as the sole manifestation of ischemia were common (74.4%). Patients with abnormal T waves in > or =1 of 6 selected abnormality categories (70.3%) had a significantly higher risk of death, acute myocardial infarction, and refractory angina (11% vs 3%; p = 0.018). Thus, T-wave abnormalities in patients presenting with non-ST-segment elevation acute coronary syndromes are common and should not automatically be regarded as benign phenomena. Quantitative T- wave analysis provides optimal risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina, Unstable / diagnosis*
  • Angina, Unstable / mortality
  • Angina, Unstable / therapy
  • Electrocardiography*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Survival Rate