• Luca Koechlin, Ivo Strebel, Tobias Zimmermann, Thomas Nestelberger, Joan Walter, Pedro Lopez-Ayala, Jasper Boeddinghaus, Samyut Shrestha, Ketina Arslani, Sabrina Stefanelli, Benedikt Reuthebuch, Desiree Wussler, Paul David Ratmann, Michael Christ, Patrick Badertscher, Karin Wildi, GiménezMaria RubiniMRCardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel, University of Basel, Switzerland; GREAT network; Cardiology Department, Herzzentrum Leipzig, Germany., Danielle M Gualandro, Òscar Miró, Carolina Fuenzalida, F Javier Martin-Sanchez, Damian Kawecki, Franz Bürgler, Dagmar I Keller, Roger Abächerli, Oliver Reuthebuch, Friedrich S Eckstein, Raphael Twerenbold, Tobias Reichlin, Christian Mueller, and APACE investigators.
• Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel, University of Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland; GREAT network.
• Ann Emerg Med. 2023 Aug 1; 82 (2): 194202194-202.

Study ObjectiveThe diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap.MethodsT-wave amplitudes were automatically measured in 12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th-percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity.ResultsMyocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction, and T-wave amplitude exceeding the 95th percentile had positive and negative lr close to 1 or with confidence intervals (CIs) crossing 1. The exceptions were leads III, aVR, and V1, which had positive lrs of 3.8 (95% CI, 2.7 to 5.3), 4.3 (95% CI, 3.1 to 6.0) and 2.0 (95% CI, 1.4 to 2.9), respectively. These leads normally have inverted T waves, so T-wave amplitude exceeding the 95th percentile reflects upright rather than increased-amplitude hyperacute T waves.ConclusionHyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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