Advertisement

Usefulness of T Wave Inversion in Leads With ST Elevation on the Presenting Electrocardiogram to Predict Spontaneous Reperfusion in Patients With Anterior ST Elevation Acute Myocardial Infarction

Published:October 30, 2013DOI:https://doi.org/10.1016/j.amjcard.2013.09.018
      Inversion of the T waves (T−) in electrocardiographic leads with ST-segment elevation after the initiation of reperfusion therapy is considered a sign of reperfusion. However, the significance of T− on presentation before the initiation of reperfusion therapy is unclear. The aim of this study was to assess whether T− on presentation predicts patency of the infarct-related artery in patients with acute ST-segment elevation myocardial infarctions (STEMIs) who undergo primary percutaneous interventions. The medical records, electrocardiograms, and angiographic findings of 209 consecutive patients who underwent emergent coronary angiography as part of primary percutaneous coronary intervention protocol activation for STEMI were reviewed. A total of 179 patients (86%) had positive T waves (T+), 16 (8%) had biphasic T waves (T+/−), and 14 (7%) had T−. Patency of the infarct-related artery (Thrombolysis In Myocardial Infarction [TIMI] flow grades 2 and 3) was seen in 64.3% of the patients in the T− group compared with only 31.2% in the T+/− group and 19.0% in the T+ group (p <0.001). Among patients with anterior STEMI, patency of the infarct-related artery was seen in all 7 patients in the T− group, compared with 50% of the 4 patients in the T+/− group and 10.1% of the 79 patients in the T+ group (p <0.001). There were no significant differences in TIMI flow grade among the groups in patients with nonanterior STEMIs (p = 0.985). In conclusion, T− in the leads with maximal ST-segment elevation on the presenting electrocardiogram was associated with higher prevalence of patency of the infarct-related artery before intervention (64.3%), especially in patients with anterior STEMIs (100%).
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • O'Gara P.T.
        • Kushner F.G.
        • Ascheim D.D.
        • Casey Jr., D.E.
        • Chung M.K.
        • de Lemos J.A.
        • Ettinger S.M.
        • Fang J.C.
        • Fesmire F.M.
        • Franklin B.A.
        • Granger C.B.
        • Krumholz H.M.
        • Linderbaum J.A.
        • Morrow D.A.
        • Newby L.K.
        • Ornato J.P.
        • Ou N.
        • Radford M.J.
        • Tamis-Holland J.E.
        • Tommaso C.L.
        • Tracy C.M.
        • Woo Y.J.
        • Zhao D.X.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2013; 127: e362-e425
        • Steg P.G.
        • James S.K.
        • Atar D.
        • Badano L.P.
        • Blomstrom-Lundqvist C.
        • Borger M.A.
        • Di Mario C.
        • Dickstein K.
        • Ducrocq G.
        • Fernandez-Aviles F.
        • Gershlick A.H.
        • Giannuzzi P.
        • Halvorsen S.
        • Huber K.
        • Juni P.
        • Kastrati A.
        • Knuuti J.
        • Lenzen M.J.
        • Mahaffey K.W.
        • Valgimigli M.
        • van 't Hof A.
        • Widimsky P.
        • Zahger D.
        ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2012; 33: 2569-2619
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        • Jaffe A.S.
        • Katus H.A.
        • Apple F.S.
        • Lindahl B.
        • Morrow D.A.
        • Chaitman B.R.
        • Clemmensen P.M.
        • Johanson P.
        • Hod H.
        • Underwood R.
        • Bax J.J.
        • Bonow J.J.
        • Pinto F.
        • Gibbons R.J.
        • Fox K.A.
        • Atar D.
        • Newby L.K.
        • Galvani M.
        • Hamm C.W.
        • Uretsky B.F.
        • Steg P.G.
        • Wijns W.
        • Bassand J.P.
        • Menasche P.
        • Ravkilde J.
        • Ohman E.M.
        • Antman E.M.
        • Wallentin L.C.
        • Armstrong P.W.
        • Simoons M.L.
        • Januzzi J.L.
        • Nieminen M.S.
        • Gheorghiade M.
        • Filippatos G.
        • Luepker R.V.
        • Fortmann S.P.
        • Rosamond W.D.
        • Levy D.
        • Wood D.
        • Smith S.C.
        • Hu D.
        • Lopez-Sendon J.L.
        • Robertson R.M.
        • Weaver D.
        • Tendera M.
        • Bove A.A.
        • Parkhomenko A.N.
        • Vasilieva E.J.
        • Mendis S.
        • Bax J.J.
        • Baumgartner H.
        • Ceconi C.
        • Dean V.
        • Deaton C.
        • Fagard R.
        • Funck-Brentano C.
        • Hasdai D.
        • Hoes A.
        • Kirchhof P.
        • Knuuti J.
        • Kolh P.
        • McDonagh T.
        • Moulin C.
        • Popescu B.A.
        • Reiner Z.
        • Sechtem U.
        • Sirnes P.A.
        • Tendera M.
        • Torbicki A.
        • Vahanian A.
        • Windecker S.
        • Morais J.
        • Aguiar C.
        • Almahmeed W.
        • Arnar D.O.
        • Barili F.
        • Bloch K.D.
        • Bolger A.F.
        • Botker H.E.
        • Bozkurt B.
        • Bugiardini R.
        • Cannon C.
        • de Lemos J.
        • Eberli F.R.
        • Escobar E.
        • Hlatky M.
        • James S.
        • Kern K.B.
        • Moliterno D.J.
        • Mueller C.
        • Neskovic A.N.
        Third universal definition of myocardial infarction.
        J Am Coll Cardiol. 2012; 60: 1581-1598
        • Jneid H.
        The 2012 ACCF/AHA focused update of the unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) guideline: a critical appraisal.
        Methodist Debakey Cardiovasc J. 2012; 8: 26-30
        • Sgarbossa E.B.
        • Meyer P.M.
        • Pinski S.L.
        • Pavlovic-Surjancev B.
        • Barbagelata A.
        • Goodman S.G.
        • Lum A.S.
        • Underwood D.A.
        • Gates K.B.
        • Califf R.M.
        • Topol E.J.
        • Wagner G.S.
        Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate.
        Am Heart J. 2000; 140: 385-394
        • Atak R.
        • Ileri M.
        • Senen K.
        • Turhan H.
        • Erbay A.R.
        • Basar N.
        • Yetkin E.
        • Demirkan D.
        Correlation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy.
        Heart Vessels. 2004; 19: 63-67
        • Atar S.
        • Barbagelata A.
        • Birnbaum Y.
        Electrocardiographic markers of reperfusion in ST-elevation myocardial infarction.
        Cardiol Clin. 2006; 24: 367-376
        • Corbalan R.
        • Prieto J.C.
        • Chavez E.
        • Nazzal C.
        • Cumsille F.
        • Krucoff M.
        Bedside markers of coronary artery patency and short-term prognosis of patients with acute myocardial infarction and thrombolysis.
        Am Heart J. 1999; 138: 533-539
        • Doevendans P.A.
        • Gorgels A.P.
        • van der Zee R.
        • Partouns J.
        • Bar F.W.
        • Wellens H.J.
        Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction.
        Am J Cardiol. 1995; 75: 1206-1210
        • Eskola M.J.
        • Holmvang L.
        • Nikus K.C.
        • Sclarovsky S.
        • Tilsted H.H.
        • Huhtala H.
        • Niemela K.O.
        • Clemmensen P.
        The electrocardiographic window of opportunity to treat vs. the different evolving stages of ST-elevation myocardial infarction: correlation with therapeutic approach, coronary anatomy, and outcome in the DANAMI-2 trial.
        Eur Heart J. 2007; 28: 2985-2991
        • Sclarovsky S.
        The evolving acute myocardial infarction.
        in: Sclarovsky S. Electrocardiography of acute myocardial ischaemic syndromes. Martin Dunitz, London, United Kingdom1999: 99-122
        • Birnbaum Y.
        • Chetrit A.
        • Sclarovsky S.
        • Zlotikamien B.
        • Herz I.
        • Olmer L.
        • Barbash G.I.
        Abnormal Q waves on the admission electrocardiogram of patients with first acute myocardial infarction: prognostic implications.
        Clin Cardiol. 1997; 20: 477-481
        • Shimada Y.J.
        • Po J.R.
        • Kanei Y.
        • Schweitzer P.
        Prognostic impact of terminal T wave inversions on presentation in patients with ST-elevation myocardial infarction undergoing urgent percutaneous coronary intervention.
        J Electrocardiol. 2013; 46: 2-7
        • Herz I.
        • Birnbaum Y.
        • Zlotikamien B.
        • Strasberg B.
        • Sclarovsky S.
        • Chetrit A.
        • Wagner G.S.
        • Barbash G.I.
        The prognostic implications of negative T waves in the leads with ST segment elevation on admission in acute myocardial infarction.
        Cardiology. 1999; 92: 121-127
        • Brener S.J.
        • Mehran R.
        • Brodie B.R.
        • Guagliumi G.
        • Witzenbichler B.
        • Cristea E.
        • Xu K.
        • Lansky A.J.
        • Stone G.W.
        Predictors and implications of coronary infarct artery patency at initial angiography in patients with acute myocardial infarction (from the CADILLAC and HORIZONS-AMI Trials).
        Am J Cardiol. 2011; 108: 918-923