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ST-Depression with Negative T Waves in Leads V4–V5—A Marker of Severe Coronary Artery Disease in Non-ST Elevation Acute Coronary Syndrome: A Prospective Study of Angina at Rest, with Troponin, Clinical, Electrocardiographic, and Angiographic Correlation

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Background: The significance of ST-segment depression in acute coronary syndrome has been the subject of debate for many decades. Studies indicate that different manifestations of ST/T changes may have significantly different prognostic implications.

Methods and Results: We studied the correlation of ST/T changes in 12-lead electrocardiography recorded during pain, to clinical and angiographic findings and in-hospital prognosis, in patients with non-ST-elevation acute coronary syndrome and elevated troponin levels. Fifty consecutive patients could be differentiated into two groups: (1) 25 patients with ST-segment depression and a negative T wave maximally in leads V4–5, (2) 25 patients with ST-segment depression and a positive T wave in the precordial lead with maximal ST-segment depression. Patients in group I had significantly more often left main or left main equivalent coronary artery disease; 76% versus 8% (P < 0.001), heart failure; 40% versus 4% (P = 0.005), and higher in-hospital mortality; 24% versus 0% (P = 0.02), than patients in group II. The troponin levels did not differ significantly between the groups.

Conclusions: In patients with non-ST-elevation acute coronary syndrome and elevated troponin levels two subgroups could be identified. Transient ST-segment depression and a negative T wave maximally in leads V4–5 during anginal pain predicts left main, left main equivalent, or severe three-vessel coronary artery disease with high sensitivity and specificity. In patients with ST-segment depression and a positive T wave, there is a high probability of one-vessel disease.
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Keywords: angina; electrocardiography; prognosis

Document Type: Research Article

Affiliations: 1: Division of Cardiology, Tampere University Hospital, Finland 2: School of Public Health, University of Tampere, Finland 3: Tel Aviv University, Israel

Publication date: July 1, 2004

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