European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(2):112-118; doi:10.1093/eurheartj/ehi026
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.
Quantitative T-wave analysis predicts 1 year prognosis and benefit from early invasive treatment in the FRISC II study population
1The Heart Center, Department of Medicine B, H:S Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
2Duke Clinical Research Institute, Durham, NC, USA
3The Heart and Lung Center, Ulleval University Hospital, Oslo, Norway
4Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
5Department of Medicine and Cardiology A, Århus University Hospital, Århus, Denmark
6Department of Cardiology, Heart Center, University Hospital, Linköping, Sweden
7Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
8Department of Medicine B, Hilleroed Hospital, Hilleroed, Denmark
Received 31 October 2003; revised 16 September 2004; accepted 30 September 2004; online publish-ahead-of-print 30 November 2004.
* Corresponding author. Department of Medicine B, Hilleroed Hospital, DK-3400 Hilleroed, Denmark. Tel: +45 48 24 60 10; fax: +45 35 45 25 13. E-mail address: mdiloujacobsen{at}dadlnet.dk
See page 103 for the editorial comment on this article (doi:10.1093/eurheartj/ehi072)
Aims To investigate the prognostic value of T-wave abnormalities in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and whether such ECG changes may predict benefit from an early coronary angiography. Although ST-segment changes are considered the most important ECG feature in NSTE-ACS, T-wave abnormalities are the most common ECG finding. We hypothesize that a new quantitative approach to T-wave analysis could improve the prognostic value of this ECG abnormality.
Methods and results Quantitative T-wave analysis was performed on the admission ECG in 1609 patients with NSTE-ACS. Nine different categories of T-wave abnormality were analysed for their prognostic value concerning clinical outcome in patients not randomized to early coronary angiography. Also, the presence of one category (i.e. T-wave abnormality in 
6 leads) was analysed for its predictive value concerning benefit from early coronary angiography. The combined study endpoint was death or myocardial infarction at 1 year follow-up. Patients with 6 leads with abnormal T-waves and concomitant ST-segment depression had a higher risk when not receiving early coronary angiography (24 vs. 12%, respectively; P=0.003), but could be brought to the same level of risk as the remaining patients with this treatment. For non-invasively treated patients five different categories of T-wave abnormality were significantly associated with an adverse outcome.
Conclusion New quantitative T-wave analysis of the admission ECG gives additional predictive information concerning clinical outcome and identifies patients who benefit from early coronary angiography.
Key Words: Acute coronary syndrome • Unstable angina pectoris • Non-ST elevation myocardial infarction
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