Document Detail

Predictive value of T-wave abnormalities at the time of emergency department presentation in patients with potential acute coronary syndromes.
MedLine Citation:
PMID:  18616439     Owner:  NLM     Status:  MEDLINE    
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.
Kathy B Lin; Frances S Shofer; Christine McCusker; Emily Meshberg; Judd E Hollander
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  15     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-07-11     Completed Date:  2008-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  537-43     Citation Subset:  IM    
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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MeSH Terms
Acute Coronary Syndrome / diagnosis*,  physiopathology*
Chi-Square Distribution
Emergency Service, Hospital / organization & administration*
Endpoint Determination
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Assessment

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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