Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non–ST-segment elevation acute coronary syndromes - 28/07/13

Doi : 10.1016/j.ahj.2013.04.010

Nigel S. Tan, MD ^a,^b,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Shaun G. Goodman, MD, MSc ^a,^b,^c,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Raymond T. Yan, MD ^b,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Basem Elbarouni, MD ^a,^b,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Andrzej Budaj, MD ^d,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Keith A.A. Fox, MB, ChB, FRCP ^e,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Joel M. Gore, MD ^f,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, David Brieger, MBBS, PhD ^g,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Jose López-Sendón, MD ^h,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Anatoly Langer, MD, MSc ^b,^c,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Frans van de Werf, MD, PhD ^i,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Ph. Gabriel Steg, MD, PhD ^j,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.}}, Andrew T. Yan, MD ^a,^b,^{^{k
On behalf of the GRACE Canadian ACS Registry Investigators. A list of participating GRACE/Expanded GRACE (GRACE²) Investigators may be found in the Am Heart J 2009:158:193–201.e1-5. A list of participating Canadian ACS Registry I & II Investigators and Coordinators may be found in the Arch Intern Med 2007;167:1009–1016.},}^{^⁎}
^a Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada
^b University of Toronto, Toronto, Ontario, Canada
^c Canadian Heart Research Centre, Toronto, Ontario, Canada
^d Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
^e Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
^f Department of Medicine, University of Massachusetts Medical School, Worcester, MA
^g Coronary Care Unit, Concord Hospital, Sydney, Australia
^h Hospital Universitario La Paz, Madrid, Spain
ⁱ Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
^j Hôpital Bichat, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique - Hôpitaux de Paris, Paris, France

^⁎Reprint requests: Andrew T. Yan, MD, St Michael's Hospital, Division of Cardiology, 30 Bond St, Room 6-030 Queen, Toronto, Ontario, Canada M5B 1W8.

Résumé

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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Vol 166 - N° 2

P. 290-297 - août 2013 Retour au numéro

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Comparative prognostic value of T-wave inversion and ST-segment depression on the admission electrocardiogram in non–ST-segment elevation acute coronary syndromes - 28/07/13

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