J Wave and Cardiac Death in Inferior Wall Myocardial Infarction

Abstract

Background and Objectives: The clinical significance of J wave presentation in acute myocardial infarction (AMI) patients remains unclear. We hypothesized that J wave appearance in the inferior leads and/or reversed-J (rJ) wave in leads V1-V3 is associated with poor prognosis in inferior-wall AMI patients. Subject and Methods: We enrolled 302 consecutive patients with inferior-wall AMI who were treated with percutaneous coronary intervention (PCI). Patients were categorized into 2 groups based on electrocardiograms before and after PCI: the J group (J waves in inferior leads and/or rJ waves in leads V1-V3) and the non-J group (no J wave in any of the 12 leads). We compared patients with high amplitude (>2 mV) J or rJ waves (big-J group) with the non-J group. The cardiac and all-cause mortality at 6 months and post-PCI ventricular arrhythmic events ≤48 hours after PCI were analyzed. Results: A total of 29 patients (including 19 cardiac death) had died. Although all-cause mortality was significantly higher in the post-PCI J group than in the non-J group (p=0.001, HR=5.38), there was no difference between the groups in cardiac mortality. When comparing the post-PCI big-J group with the non-J group, a significant difference was found in all-cause mortality (n=29, p=0.032, HR=5.4) and cardiac mortality (n=19, p=0.011, HR=32.7). Pre-PCI J waves were associated with a higher prevalence of post-AMI ventricular arrhythmia (p=0.016, HR=31.67). Conclusion: High-amplitude J waves in inferior leads and/or rJ waves in leads V1-V3 were possible prognostic factors of all-cause and cardiac mortality in patients with inferior-wall AMI.