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Predictive Value of T‐wave Abnormalities at the Time of Emergency Department Presentation in Patients with Potential Acute Coronary Syndromes
Author(s) -
Lin Kathy B.,
Shofer Frances S.,
McCusker Christine,
Meshberg Emily,
Hollander Judd E.
Publication year - 2008
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2008.00135.x
Subject(s) - medicine , emergency department , acute coronary syndrome , myocardial infarction , cardiology , t wave , revascularization , prospective cohort study , left bundle branch block , electrocardiography , cohort , u wave , st segment , heart failure , psychiatry
Objectives: T‐wave abnormalities on electrocardiograms (ECGs) are common, but their ability to predict 30‐day cardiovascular outcomes at the time of emergency department (ED) presentation is unknown. The authors determined the association between T‐wave abnormalities on the presenting ECG and cardiovascular outcomes within 30 days of presentation in patients with potential acute coronary syndromes (ACSs). Methods: This was a secondary analysis of a prospective cohort study of ED patients that presented with a potential ACS. Patients were excluded if they had a prior myocardial infarction, ST‐segment elevation or depressions, right or left bundle branch block, or Q‐waves on the initial ECG. Data included demographics, medical and cardiac history, and ECG findings including the presence or absence of T‐wave flattening, inversions of 1–5 mm, and inversions >5 mm. Investigators followed the hospital course for admitted patients, and 30‐day follow‐up was performed on all patients. The main outcome was a composite of death, acute myocardial infarction, revascularization, coronary stenosis greater than 50%, or a stress test with reversible ischemia. Results: Of 8,298 patient visits, 5,582 met criteria for inclusion: 4,166 (74.6%) had no T‐wave abnormalities, 721 (12.9%) had T‐wave flattening in two or more leads, 659 (11.8%) had T‐wave inversions of 1–5 mm, and 36 (0.64%) had T‐wave inversions >5 mm. The composite endpoint was more common in patients with T‐wave flattening (8.2% vs. 5.7%; p = 0.0001; relative risk [RR] = 1.4; 95% confidence interval [CI] = 1.1 to 1.9), T‐wave inversions 1–5 mm (13.2% vs. 5.7%; p = 0.0001; RR = 2.4; 95% CI = 1.8 to 3.1), and T‐wave inversions >5 mm (19.4% vs. 5.7%; p = 0.0001; RR = 3.4; 95% CI = 1.7 to 6.1), or any T‐wave abnormality (10.8% vs. 5.7%; p = 0.0001; RR = 1.9; 95% CI = 1.6 to 2.3), even after adjustment for initial troponin. This association also existed in the subset of patients without known coronary artery disease. Conclusions: In patients with potential ACS presenting to the ED, T‐wave abnormalities are associated with higher rates of 30‐day cardiovascular events.