An increased T-wave complexity ratio on the presenting ECG was strongly associated with NSTEMI (OR 3.8; 95% CI 2.1-5.8) and in-hospital MACE (OR 8.2; 95% CI 3.1-21.5).
Observational (n=369)
Does ventricular repolarization dispersion on presenting ECG detect NSTEMI and predict in-hospital MACE in emergency department patients with chest pain?
Ventricular repolarization dispersion measured via T-wave complexity ratio on presenting ECG can help detect NSTEMI and predict in-hospital MACE in patients with chest pain.
Effect estimate: OR 3.8 (95% CI 2.1 to 5.8)
BACKGROUND: A specific electrocardiographic (ECG) marker of ischemia would greatly improve the speed and accuracy of detecting and treating non-ST elevation myocardial infarction (NSTEMI). We hypothesize that ischemia induces ventricular repolarization dispersion (VRD), altering the T-wave before any ST segment deviation. We sought to evaluate the clinical utility of VRD to (1) detect NSTEMI cases in the emergency department (ED) and (2) identify NSTEMI cases at high risk for in-hospital major adverse cardiac events (MACEs). METHODS AND RESULTS: We continuously recorded 12-lead Holter ECGs from chest pain patients upon their arrival to the ED. VRD was quantified using principal component analysis of the 12-lead ECG to compute a T-wave complexity ratio (ie, ratio of second to first eigenvectors of repolarization). Clinical outcomes were obtained from hospital records. The sample was composed mainly of older males (n=369; ages 63±12 years; 63% males), and 92 (25%) had NSTEMI and 26 (7%) had MACEs. Baseline T-wave complexity ratio modestly correlated with peak troponin levels (r=0.41; P<0.001) and was a good classifier of NSTEMI events (area under the curve=0.70). An increased T-wave complexity ratio on the presenting ECG was strongly associated with NSTEMI (odds ratio OR=3.8 2.1 to 5.8) and in-hospital MACE (OR=8.2 3.1 to 21.5). CONCLUSIONS: A simple measure of global VRD on the presenting 12-lead ECG correlates with ischemic myocardial injury and can discriminate NSTEMI cases very early during evaluation. Prospective studies should validate these findings and test whether VRD can guide therapy.
Al‐Zaiti et al. (Fri,) conducted a observational in Chest pain (n=369). Ventricular repolarization dispersion (T-wave complexity ratio) was evaluated on Non-ST elevation myocardial infarction (NSTEMI) (OR 3.8, 95% CI 2.1 to 5.8). An increased T-wave complexity ratio on the presenting ECG was strongly associated with NSTEMI (OR 3.8; 95% CI 2.1-5.8) and in-hospital MACE (OR 8.2; 95% CI 3.1-21.5).