The prognostic implications of negative T waves in the leads with ST segment elevation on admission in acute...

Area of Science:

• Cardiology
• Emergency Medicine
• Medical Diagnostics

Background:

• ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment.
• Electrocardiogram (ECG) findings on admission can provide prognostic information.
• The significance of negative T waves in ST-elevation leads during acute myocardial infarction (AMI) is not fully understood.

Purpose of the Study:

• To evaluate the prognostic value of negative T waves in ST-elevation leads in patients with AMI treated with thrombolysis.
• To determine if the timing of treatment initiation influences the prognostic significance of these ECG findings.

Main Methods:

• A retrospective analysis of 2,853 patients with AMI treated with thrombolysis.
• Patients were categorized based on the presence (T+) or absence (T-) of negative T waves in ST-elevation leads on admission ECG.
• Prognostic outcomes, including hospital mortality, were compared between groups, considering treatment delay.

Main Results:

• Negative T waves (T-) were observed in 9% of patients.
• For patients treated within 2 hours of symptom onset, T- waves were associated with no hospital mortality (0%) compared to 5.0% in T+ patients (p=0.19).
• For patients treated more than 2 hours after symptom onset, T- waves were linked to higher mortality (10.2%) than T+ waves (5.4%; p=0.01).
• Multivariate analysis confirmed T- waves as an independent predictor of mortality in patients treated >2 hours post-onset (OR 1.86, p=0.017).

Conclusions:

• Negative T waves in ST-elevation leads on admission have a dichotomous prognostic significance in STEMI patients treated with thrombolysis.
• Early treatment (
• Delayed treatment (>2 hours) with negative T waves is associated with an adverse prognosis and increased mortality.