The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery

Abdolmohammad Ranjbar,Reza Hajizadeh,Seyyed-Reza Sadat-Ebrahimi,Bahram Sohrabi,Naser Aslanabadi,Babak Seyvani,Samad Ghaffari,Babak Kazemi

doi:10.1186/s12872-021-01851-8

Abstract

BackgroundUp to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions. Our objective was to evaluate the applicability of T wave inversion in electrocardiography (ECG) of patients with STEMI as an indicator of early spontaneous reperfusion.MethodsIn this prospective study, patients with STEMI admitted to a tertiary referral hospital were studied over a 3-year period. ECG was obtained at the time of admission and patients underwent a PPCI. The association between early T wave inversion and patency of the infarct-related artery was investigated in both anterior and non-anterior STEMI.ResultsOverall, 1025 patients were included in the study. Anterior STEMI was seen in 592 patients (57.7%) and non-anterior STEMI in 433 patients (42.2%). Among those with anterior STEMI, 62 patients (10.4%) had inverted T and 530 (89.6%) had positive T waves. In patients with anterior STEMI and inverted T waves, a significantly higher TIMI flow was detected (p value = 0.001); however, this relationship was not seen in non-anterior STEMI.ConclusionIn on-admission ECG of patients with anterior STEMI, concomitant inverted T wave in leads with ST elevation could be a proper marker of spontaneous reperfusion of infarct related artery.

Highlights

Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions
In 67 patients, there was a positive history of Myocardial infraction (MI) or coronary artery bypass grafting (CABG); in 20 patients, left bundle branch block (LBBB), right bundle branch block (RBBB) or intraventricular conduction delay (IVCD) was present; in 24 patients, duration of chest pain was longer than 6 h; and in 14 patients, streptokinase was administrated prior to hospital admission
No significant difference was seen in baseline characteristics of those with inverted T wave and those with positive T waves (Table 1)

Summary

Introduction

Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions. Primary percutaneous coronary intervention (PPCI) and thrombolytic therapy have been suggested as the essential therapeutic techniques in the management of patients with acute ST-elevation myocardial infarction (STEMI) [1]. It has been reported by some angiographic studies that 7–57% of patients with STEMI developed spontaneous reperfusion (SR) prior to PPCI [2,3,4,5,6,7]. The aim of this study was to evaluate the association of on admission T wave inversion in the presenting ECG of acute STEMI patients undergoing PPCI with spontaneous reperfusion of the infarct related artery

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Discussion

Conclusion