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

2014 
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 adj ] 2.35, p = 0.04) during follow-up and VT ≥4 beats (OR adj 2.70, p = 0.01) during hospitalization with a trend toward increased cardiovascular death risk (OR adj 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
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