Iranian Heart Journal

Iranian Heart Journal

The Clinical Impact of the Dynamic Morphology of T-Wave Inversion After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Document Type : Original Article

Authors
Jongkwon Seo
Byung Gyu Kim
Moo-Nyun Jin
Hye Young Lee
Byung Ok Kim
Young Sup Byun
Gwangsil Kim
Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Seoul, Korea.
Abstract
Background: T-wave inversion, which develops shortly after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), is related to reperfusion or myocardial viability. We aimed to evaluate the clinical outcome according to changes in T-wave inversion in patients with STEMI.
Methods: We categorized patients into 3 groups according to T-wave morphology after primary PCI: no newly developed T-wave inversion, newly developed T-wave inversion but resolved within 6 months (recovered T-wave), and newly developed T-wave inversion and persistent over 6 months (persistent T-wave). Newly developed T-wave inversion was defined as new-onset T-wave inversion within 48 hours after primary PCI. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), comprising cardiac death, myocardial infarction, target vessel revascularization, stroke, and re-hospitalization for heart failure.
Results: A total of 299 patients were analyzed and followed up for a mean of 25 months. Among them, 70, 158, and 71 had no newly developed T-wave inversion, recovered inversion, and persistent inversion, respectively. The cumulative MACCE rate was significantly lower in patients with recovered inversion than in those with no or persistent inversion (10.1% vs 21.4% vs 18.3%, respectively; P=0.04). In multivariate Cox regression analysis, the no T-wave inversion group (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.0 to 4.39; P=0.05) and the persistent T-wave inversion group (HR, 1.98; 95% CI, 0.93 to 4.18; P=0.07) were associated with more frequent MACCE.
Conclusions: Newly developed T-wave inversion that disappears within 6 months was associated with a favorable long-term outcome compared with no newly developed or persistent T-wave inversion. (Iranian Heart Journal 2022; 23(2): 26-33)
Keywords
ST-elevation myocardial infarction
T-wave inversion
Clinical outcome
  1. Reindl M, Reinstadler SJ, Feistritzer HJ, Niess L, Koch C, Mayr A, et al. Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction. Int J Cardiol. 2017; 241:76-82.
  2. Matetzky S, Barabash GI, Shahar A, Rabinowitz B, Rath S, Zahav YH, et al. Early T wave inversion after thrombolytic therapy predicts better coronary perfusion: clinical and angiographic study. J Am Coll Cardiol. 1994; 24(2):378-83.
  3. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2019. European heart journal. 2020; 41(1):12-85.
  4. Lüscher TF, Obeid S. From Eisenhower's heart attack to modern management: a true success story! European heart journal. 2017; 38(41):3066-9.
  5. Tamita K, Yamamuro A, Hashimura H, Maeda M, Tokuda T, Yoshida K, et al. Enhancement patterns detected by multidetector computed tomography are associated with the long-term prognosis of patients with acute myocardial infarction. Heart and vessels. 2021.
  6. Petriz JL, Gomes BF, Rua BS, Azevedo CF, Hadlich MS, Mussi HT, et al. Assessment of myocardial infarction by cardiac magnetic resonance imaging and long-term mortality. Arquivos brasileiros de cardiologia. 2015; 104(2):159-68.
  7. Hung CL, Verma A, Uno H, Shin SH, Bourgoun M, Hassanein AH, et al. Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction. J Am Coll Cardiol. 2010; 56(22):1812-22.
  8. Corbalan R, Prieto JC, Chavez E, Nazzal C, Cumsille F, Krucoff M. Bedside markers of coronary artery patenacy and short-term prognosis of patients with acute myocardial infarction and thrombolysis. Am Heart J. 1999; 138(3 Pt 1):533-9.
  9. Lee MJ, Jang JH, Lee MD, Kwon SW, Shin SH, Park SD, et al. Prognostic Implications of Newly Developed T-Wave Inversion After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017; 119(4):515-9.
  10. Kosuge M, Kimura K, Nemoto T, Shimizu T, Mochida Y, Nakao M, et al. [Clinical significance of inverted T-waves during the acute phase of myocardial infarction in patients with myocardial reperfusion]. J Cardiol. 1995; 25(2):69-74.
  11. Flore V, Claus P, Vos MA, Vandenberk B, Van Soest S, Sipido KR, et al. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction. J Cardiovasc Transl Res. 2015; 8(8):484-92.
  12. Maeda S, Imai T, Kuboki K, Chida K, Watanabe C, Ohkawa S. Pathologic implications of restored positive T waves and persistent negative T waves after Q wave myocardial infarction. J Am Coll Cardiol. 1996; 28(6):1514-8.
  13. Eskola MJ, Holmvang L, Nikus KC, Sclarovsky S, Tilsted HH, Huhtala H, et al. 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(24):2985-91.
  14. Alsamara M, Degheim G, Gholkar G, Hiner E, Zughaib M. Is symptom to balloon time a better predictor of outcomes in acute ST-segment elevation myocardial infarction than door to balloon time? American journal of cardiovascular disease. 2018; 8(4):43-7.
  15. Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998; 32(5):1312-9.
  16. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109(10):1223-5.
  17. Nallamothu BK, Bradley EH, Krumholz HM. Time to treatment in primary percutaneous coronary intervention. The New England journal of medicine. 2007; 357(16):1631-8.
  18. Denktas AE, Anderson HV, McCarthy J, Smalling RW. Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC Cardiovascular interventions. 2011; 4(6):599-604.
  19. Her AY, Cho KI, Singh GB, An DS, Jeong YH, Koo BK, et al. Plaque characteristics and inflammatory markers for the prediction of major cardiovascular events in patients with ST-segment elevation myocardial infarction. The international journal of cardiovascular imaging. 2017; 33(10):1445-54.
  20. Reinstadler SJ, Reindl M, Feistritzer HJ, Klug G, Mayr A, Kofler M, et al. Prognostic significance of transaminases after acute ST-elevation myocardial infarction: insights from a cardiac magnetic resonance study. Wiener klinische Wochenschrift. 2015; 127(21-22):843-50.
Iranian Heart Journal
Volume 23, Issue 2
Spring 2022
Pages 26-33