Display Settings:

Format

Send to:

Choose Destination
Am J Cardiol. 2014 Jul 1;114(1):17-23. doi: 10.1016/j.amjcard.2014.03.056. Epub 2014 Apr 16.

Relation of T-wave alternans to mortality and nonsustained ventricular tachycardia in patients with non-ST-segment elevation acute coronary syndrome from the MERLIN-TIMI 36 trial of ranolazine versus placebo.

Author information

  • 1University of Helsinki and Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
  • 2Harvard Medical School, Boston, Massachusetts; Thrombolysis in Myocardial Infarction (TIMI) Study Group and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • 3Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • 4Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
  • 5Thrombolysis in Myocardial Infarction (TIMI) Study Group and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • 6Gilead Sciences, Foster City, California.
  • 7Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: rverrier@bidmc.harvard.edu.

Abstract

We explored the utility of T-wave alternans (TWA) in predicting mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Maximum TWA was calculated using Modified Moving Average method from continuous electrocardiographic recordings in patients with left ventricular ejection fraction <40% and ventricular tachycardia (VT) ≥4 beats during index hospitalization or sudden cardiac death during the follow-up year and age- and sex-matched controls in the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction (MERLIN-TIMI) 36 trial. All patients received standard therapy for NSTEACS plus ranolazine (n = 109) or placebo (n = 101). Median follow-up was 1 year. Baseline clinical characteristics did not differ between patients with elevated TWA (≥47 μV) compared with lower levels. Patients with TWA ≥47 μV at admission had increased risk of total mortality (adjusted odds ratio [ORadj] 2.35, p = 0.04) during follow-up and VT ≥4 beats (ORadj 2.70, p = 0.01) during hospitalization with a trend toward increased cardiovascular death risk (ORadj 2.18, p = 0.07) during follow-up. In patients receiving placebo, TWA ≥47 μV on day 6 was associated with increased risk of total mortality (OR 4.12, 95% confidence interval 1.25 to 13.64, p = 0.02) and cardiovascular death (OR 4.73, p = 0.01) during follow-up. No deaths occurred among patients with TWA ≥47 μV assigned to ranolazine. In conclusion, in patients with NSTEACS and left ventricular ejection fraction <40%, TWA ≥47 μV early after admission is associated with increased risk of mortality at 1 year and with nonsustained VT during hospitalization. TWA may be useful in risk estimation in patients with NSTEACS. The possibility that TWA may serve as a therapeutic target deserves further exploration.

Copyright © 2014 Elsevier Inc. All rights reserved.

PMID:
24852915
[PubMed - in process]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk