Differences in Negative T Waves Between Acute Pulmonary Embolism and Acute Coronary Syndrome

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Background: Patients with acute pulmonary embolism (APE) often have negative T waves (Neg T) in precordial leads at presentation, but this is also found in acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease. Methods and Results: Differences in Neg T on admission electrocardiograms were studied between 107 patients with APE and 248 patients with ACS caused by LAD disease. All patients had Neg T in leads V₁–₄ and were admitted within 7 days from symptom onset. The number of leads with Neg T (4.8±1.8 vs. 5.5±1.7, P<0.001) and maximum magnitude of Neg T (3.4±2.0 vs. 4.7±3.3mm, P<0.001) were lower in APE. The frequency of occurrence of Neg T in each of the 12 leads, and the precordial lead with the greatest Neg T (peak Neg T) differed between APE and ACS (all P<0.05, respectively). APE was strongly associated with the presence of Neg T in both leads III and V₁ and peak Neg T in leads V_1–2. The combination of these 2 findings identified APE with 98% sensitivity, 92% specificity, and 94% predictive accuracy, which represented the highest diagnostic accuracy. Conclusions: Among patients with APE and ACS who have precordial Neg T, the presence of Neg T in leads III and V₁ and/or peak Neg T in leads V_1–2 simply but accurately differentiates APE from ACS.  (Circ J 2014; 78: 483–489)