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European Heart Journal Advance Access published online on November 30, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi026
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Quantitative T-wave analysis predicts 1 year prognosis and benefit from early invasive treatment in the FRISC II study population

Michael D. Jacobsen 1*, Galen S. Wagner 2, Lene Holmvang 1, Frederic Kontny 3, Lars Wallentin 4, Steen Husted 5, Eva Swahn 6, Elisabeth Ståhle 7, Rolf Steffensen 8, and Peter Clemmensen 1

1 The Heart Center, Department of Medicine B, H:S Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
2 Duke Clinical Research Institute, Durham, NC, USA
3 The Heart and Lung Center, Ulleval University Hospital, Oslo, Norway
4 Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
5 Department of Medicine and Cardiology A, Århus University Hospital, Århus, Denmark
6 Department of Cardiology, Heart Center, University Hospital, Linköping, Sweden
7 Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
8 Department of Medicine B, Hilleroed Hospital, Hilleroed, Denmark

* To whom correspondence should be addressed.
Michael D. Jacobsen, E-mail: mdiloujacobsen{at}dadlnet.dk


  Abstract

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.

Keywords: Acute coronary syndrome; Unstable angina pectoris; Non-ST elevation myocardial infarction.
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Assessing risk in FRISC
Eur. Heart J., January 2, 2005; 26(2): 103 - 104.
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