Meyers H Pendell, Simančík František, Herman Robert, Rafajdus Adam, Frick William H, Nunes de Alencar José, Aslanger Emre K, Smith Stephen W
Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, USA; Powerful Medical, Bratislava, Slovakia.
Powerful Medical, Bratislava, Slovakia.
JACC Adv. 2025 Aug 11:102120. doi: 10.1016/j.jacadv.2025.102120.
Despite no objective definition, hyperacute T waves (HATW) are recommended by the American College of Cardiology as a STEMI equivalent finding, requiring emergent reperfusion.
We sought to derive and validate a quantitative definition of HATW.
We retrospectively evaluated adults with possible ACS across five PCI centers. Exclusions were: lack of pre-angiogram ECG, QRS duration ≥110 ms, and elevated troponin without angiogram. The outcome definition was: myocardial infarction with TIMI 0-1 flow culprit lesion. ECG measures included T wave magnitude (T wave area relative to QRS amplitude) and symmetry (T wave peak-to-end time relative to onset-to-peak time). The HATW score was derived and evaluated on separate groups. The primary analysis was HATW score performance for acute coronary occlusion in patients without STEMI criteria.
3,274 patients were reviewed, and 618 were excluded. 1,261 and 1,395 patients were allocated to derivation and validation groups. In derivation the optimal HATW score threshold for ≥ 98% specificity was: 2 consecutive leads with mean HATW score ≥ 0.7. In validation the performance for acute coronary occlusion in the subset without STEMI criteria (N = 1300) was: 98.4% specificity, 20.7% sensitivity, 47.4% PPV, 12.54 LR+. Among patients without STEMI criteria but positive HATW score, 84% had a culprit lesion causing AMI.
The HATW score is the first objective definition of hyperacute T waves showing significant clinical utility as an ECG finding of acute coronary occlusion in potential ACS patients.
尽管尚无客观定义，但美国心脏病学会将超急性T波（HATW）推荐为等同于ST段抬高型心肌梗死（STEMI）的发现，需要紧急再灌注治疗。
我们试图得出并验证HATW的定量定义。
我们对五个PCI中心的疑似急性冠状动脉综合征（ACS）成人患者进行了回顾性评估。排除标准为：缺乏血管造影术前心电图、QRS时限≥110毫秒以及肌钙蛋白升高但未行血管造影。结局定义为：罪犯病变处TIMI血流0 - 1级的心肌梗死。心电图测量指标包括T波幅度（T波面积相对于QRS波振幅）和对称性（T波峰至终点时间相对于起始至峰值时间）。HATW评分在不同组中得出并进行评估。主要分析是无STEMI标准患者中HATW评分对急性冠状动脉闭塞的表现。
共评估了3274例患者，排除618例。1261例和1395例患者分别分配至推导组和验证组。在推导组中，特异性≥98%时的最佳HATW评分阈值为：连续2个导联平均HATW评分≥0.7。在验证组中，无STEMI标准亚组（N = 1300）中急性冠状动脉闭塞的表现为：特异性98.4%，敏感性20.7%，阳性预测值47.4%，阳性似然比12.54。在无STEMI标准但HATW评分阳性的患者中，84%有导致急性心肌梗死的罪犯病变。
HATW评分是超急性T波的首个客观定义，作为潜在ACS患者急性冠状动脉闭塞的心电图表现具有显著临床应用价值。
