Prognostic Value of T peak-T end Interval on Surface ECG in Patients Undergoing Reperfusion Therapy for ST Segment Myocardial Infarction

Abstract

Background: In post-ST-segment elevation myocardial infarction (STEMI) patients, the indices of repolarization on electrocardiogram (ECG) have shown promise for the prediction of death and malignant arrhythmias. In our study, we analyzed prospectively, in patients with STEMI undergoing reperfusion therapy, the acute effects of the reperfusion on the Tpeak-Tend (TpTe) and its predictive value for 30-day mortality, ventricular arrhythmias, and heart failure. Materials and Methods: We studied 75 STEMI patients aged 18–80 years admitted to Nizam’s Institute of Medical Sciences, Hyderabad, over 6 months. ECGs were taken before and 90 min after reperfusion. TpTe interval was measured before (pre-TpTe) and after reperfusion (post-TpTe). 24-h Holter monitoring was recorded within 72 h of reperfusion to look for any arrhythmias. Patients were followed up for a period of 30 days, and all the major adverse cardiac events (MACE) if any, were noted. Results: In the primary percutaneous transluminal coronary angioplasty (PTCA) group, the mean change in TpTe after intervention was 19.7 ± 16.7 ms, whereas in thrombolysis group, it was 10.7 ± 13.8; and the difference was statistically significant (P < 0.05), suggesting the superiority of primary PTCA compared to thrombolysis. When pre-TpTe interval was compared between who survived (69) and who succumbed (09), higher values were seen in patients who succumbed to death (115 ± 5.48) versus (88 ± 16.5) (P < 0.05). Pre-TpTe value of 105 had 100% sensitivity and 83% specificity in predicting mortality. Conclusion: Primary PTCA was superior to thrombolysis in reducing the TpTe interval and MACE events. The pre-TpTe interval could predict 30-day mortality and ventricular arrhythmias in the immediate and late period after revascularization in STEMI.