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The current guidelines for the management of non-ST elevation acute coronary syndrome include T-wave inversion and ST-segment depression as a manifestation of ischemia. However, the clinical implication of T-wave inversion has not been evaluated specifically in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
We retrospectively reviewed 481 consecutive NSTEMI patients who underwent coronary angiography. NSTEMI was diagnosed according to the third universal definition of myocardial infarction. ST segments were classified into four categories: T-wave inversion (≥0.1mV in more than two contiguous leads), ST depression (≥0.05mV), strain-pattern ST change, or no ST change. Obstructive coronary artery was defined as stenosis ≥70% (50% for left main). Impaired coronary flow was defined as TIMI flow grade of less than 3. Angiographic findings were compared between patients with T-wave inversion and no ST change.
Among 481 patients, 109 patients (23%) had T-wave inversion, 155 patients (32%) had ST depression, and 191 patients (40%) had no ST change. There was no significant difference between patients with T-wave inversion and those without ST change in the rate of obstructive coronary artery (73% vs. 75 %, p=0.58), impaired coronary flow (39% vs. 39%, p=0.97), or in-hospital revascularization (58% vs. 60%, p=0.68). On analysis stratified according to the depth and the number of leads with T-wave inversion, neither deep nor diffuse T-wave inversion was associated with obstructive coronary artery or impaired coronary flow.
T-wave inversion, even deep or diffuse T-wave inversions, did not increase the likelihood of obstructive coronary artery or impaired coronary flow in NSTEMI patients.