Value of T Wave Inversion in the Presenting ECG in Patients with Anterior ST Elevation Acute Myocardial Infarction as a Predictor of Spontaneous Reperfusion

Abstract

T wave inversion in leads with ST-segment elevation after the initiation of reperfusion therapy is considered a sign of reperfusion. However, the significance of T wave inversion on presentation before the initiation of reperfusion therapy is unclear. The current study aimed to assess whether T wave inversion on presentation can predict patency of the infarct related artery (IRA) in patients with Acute Anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI). The study included 90 patients presented to the emergency department with acute anterior ST-elevation myocardial infarction. The following patients were excluded from the study: Patients with left bundle branch or right bundle branch block, Patients with paced Rhythm and patients who received thrombolytic therapy. The T wave morphology in the 2 leads with maximal ST-segment elevation on the presenting ECG were identified according to the following defenetion: Positive T waves: T‏+; initial Positive deflection ≥ 0.5 mm above the isoelectric line. Biphasic T waves: T +‏/- ; initial positive deflection above the ST segment follows by negative deflection ≥ 0.5 mm below the isoelectric line. Negative T waves: T-; initial negative deflection≥ _0.5 mm below the isoelectric line without initial positive deflection. Then according to the results of the initial angiography, patients were classified to spontaneous reperfusion (TIMI II or TIMI III) and non spontaneous reperfusion (TIMI flow 0 or TIMI I). Then intervention was done with recording of all procedure data including procedure complications and after end of the procedure patient were kept and followed up in CCU with recording of in hospital MACE.  Among the whole study group 40 patients (44.4%) had positive T Waves (T+), 34 Patients (37.8%) had Negative T Waves (T-) and 16 patients (17.8%) had Biphasic T Waves (T+/-).  Initial angiogram showed that (18) patient had spontaneous reperfusion and (72) patients had no spontaneous reperfusion.  The demographic criteria of non spontaneous reperfusion group were statistically similar to spontaneous reperfusion group with exception of age, as patients of non spontaneous reperfusion group were younger than the spontaneous reperfusion group (51.56±9.30 years versus 56.85±10.23), p value (0.049).