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Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival
E B Sgarbossa1, P M Meyer, S L Pinski
1Section of Cardiology, Rush-Presbyterian Medical Center, Chicago, IL 60612, USA. esgarbos@rush.edu
Insights
Negative T waves after acute myocardial infarction indicate better outcomes. Patients with negative T waves showed improved 30-day survival rates, suggesting a positive prognostic marker.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Diagnostics
Background:
- Negative T waves in acute coronary events are linked to Thrombolysis In Myocardial Infarction (TIMI) flow grade 3.
- These ECG findings correlate with better ventricular function, not ongoing ischemia.
Purpose of the Study:
- To investigate the prognostic significance of negative T waves following acute myocardial infarction (AMI) treated with thrombolysis.
- To determine if negative T waves predict survival outcomes in AMI patients.
Main Methods:
- Analysis of 1505 patients from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiographic substudy.
- Patients survived at least 24 hours post-thrombolysis with no confounding ECG factors.
Main Results:
- 62% of patients (n=938) developed negative T waves (NT group).
- The NT group had significantly lower 30-day mortality (1.3% vs. 4.4%, P <.001).
- Negative T waves independently predicted improved survival (OR 0.38, P =.007) after covariate adjustment.
Conclusions:
- Negative T waves observed shortly after thrombolysis for AMI are associated with improved 30-day survival.
- These findings suggest negative T waves may serve as a favorable prognostic indicator in AMI patients.
- Further prospective studies are recommended to validate this association.
Background:
Recent studies have reported that negative T waves in the setting of acute coronary events are associated with Thrombolysis In Myocardial Infarction flow grade 3 in the infarct-related artery and with improved parameters of ventricular function rather than with ischemia.
Methods:
Patients enrolled in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiographic substudy (ie, patients with acute infarction randomly assigned to one of 4 thrombolytic regimens who then underwent coronary angiography) were included in this study if they survived at least 24 hours and had no confounding electrocardiographic factors (n = 1505).
Results:
More patients had negative T waves develop (NT group, n = 938 [62%]) than not (PT group, n = 567 [38%]). Peak creatine kinase MB, time to thrombolysis, and randomization to accelerated alteplase were no different between the groups. Thirty days after admission, 12 patients in the NT group had died versus 25 patients in the PT group (1.3% vs. 4.4%; P <.001; odds ratio for negative T waves 0.28; 95% confidence interval 0.14-0.56). The difference persisted when only patients who survived at least 3 days were analyzed. After adjusting for relevant covariates (including presence of new Q waves in the follow-up electrocardiogram), negative T waves were an independent predictor for survival (P =. 007; odds ratio for negative T waves 0.38; 95% confidence interval 0. 18-0.78). Patients in the NT group were 35% more likely to have achieved patency of the infarct-related artery, although this difference was not statistically significant.
Conclusions:
Negative T waves shortly after acute myocardial infarction treated with thrombolysis were markers for improved 30-day survival rate. This finding merits prospective testing.