ArticleJACC. Advances2025
Hyperacute T Waves Are Specific for Occlusion Myocardial Infarction, Even Without Diagnostic ST-Segment Elevation.
Article in JACC. Advances, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Improved Detection of Acute Coronary Occlusion Myocardial Infarction by an Artificial Intelligence Electrocardiogram Model in Swedish Emergency Departments.Journal of the American College of Emergency Physicians open · 2026Article
- Evidence for Electrocardiographic Patterns Identifying Acute Coronary Occlusion in Non-ST-Elevation Acute Coronary Syndromes: A Scoping Review.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man.JACC. Case reports · 2026Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite no objective definition, hyperacute T waves (HATWs) are recommended by the American College of Cardiology as a ST-segment elevation myocardial infarction (STEMI) equivalent finding, requiring emergent reperfusion.
objectivesWe sought to derive and validate a quantitative definition of HATW.
methodsWe retrospectively evaluated adults with possible acute coronary syndrome across five percutaneous coronary intervention centers. Exclusions were lack of preangiogram ECG, QRS duration ≥110 ms, and elevated troponin without angiogram. The outcome definition was myocardial infarction with TIMI flow grade 0-1 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.
results3,274 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 = 1,300) was 98.4% specificity, 20.7% sensitivity, 47.4% positive predictive value, and 12.54 positive likelihood ratio. Among patients without STEMI criteria but positive HATW score, 84% had a culprit lesion causing acute myocardial infarction.
conclusionsThe HATW score is the first objective definition of HATW showing significant clinical utility as an ECG finding of acute coronary occlusion in potential acute coronary syndrome patients.
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