Significance of Abnormal T Waves in Acute Coronary Syndrome without ST Changes in ECG

ABSTRACT

T-wave abnormalities are common electrocardiographic occurrences in patients with acute coronary syndromes. The clinical and electrocardiographic course and angiographic findings in patients with evolving inverted or biphasic T waves have not been fully elucidated. Patients with abnormal T waves associated with unstable angina represent a subgroup with a high probability of near total obstruction of coronary artery and myocardial dysfunction. In the present study we describe a subgroup of patients with myocardial ischemia who during the acute Ischemic phase did not develop elevation but only biphasic or inverted T waves in the ECG and had >90% stenosis of 1 or more coronary arteries. Methods: The study comprised 125 patients presented with unstable angina pectoris. Patients’ characteristics, Electrocardiographic Data, Cardiac enzymes and Coronary angiography findings were obtained. Collected data was analyzed and sensitivity, specificity, positive predictive value, significance of test (p value) were calculated using appropriate statistical method. Results: Of the 125 patients deep symmetrical and sustained T-wave inversions were present in 72 patients & biphasic T-waves in 28 patients. 125 patients underwent coronary angiography, 92(74%) patients had >90% stenosis of 1 or more coronary arteries; sensitivity of abnormal T waves for significant stenosis was 90%, specificity 92%, positive predictive value 97.83 % and p value <0.001. Conclusion: We have identified a subgroup of patients with critical obstruction of coronary artery in patients with unstable angina and non diagnostic ECG T-wave abnormalities are significant electrocardiographic occurrences in patients with acute coronary syndromes and frequently associated with coronary artery obstruction