Can the T-wave predict sudden cardiac death in coronary disease?

Sudden cardiac death (SCD) remains a major public health burden, claiming an estimated 250 000 lives annually in the European Union.1 While most SCD cases are still attributable to coronary artery disease (CAD),2 prompt revascularisation and modern medical therapy have markedly improved outcomes in acute coronary syndrome (ACS). Currently, the long-term prognosis following ACS is excellent, with the annual incidence of SCD being as low as 0.5%.3 At present, our ability to predict which patients with CAD are at the highest risk remains limited. Current ESC guidelines base primary prevention with implantable cardioverter-defibrillators (ICDs) almost exclusively on left ventricular ejection fraction (LVEF), recommending device therapy for those whose LVEF persists at ≤30–35% despite optimal medical therapy.4 This strategy is far from satisfactory: many patients with preserved systolic function die suddenly, while most ICD recipients never experience a life-saving shock. A more refined approach is urgently needed.