title: The prognostic implications of negative T waves in the leads with ST segment elevation on admission in acute myocardial infarction.
abstract: We assessed the prognostic significance of negative T waves on admission in leads with ST elevation in 2,853 patients with acute myocardial infarction treated with thrombolysis. Patients were classified into 2 groups based on the presence of negative (T-) or positive (T+) T waves in the leads with ST elevation on admission. T+ and T- waves on admission were detected in 2,601 (91%) and 252 (9%) patients, respectively. T- waves were observed in 6.7 and 9.6% of patients admitted </=2 and 2-6 h after onset of infarction, respectively. There was a difference in prognosis between patients admitted </=2 and >2 h after symptom onset. T- patients admitted </=2 h after onset had no hospital mortality (0/52 patients), as compared to a 5.0% mortality rate in T+ patients (36/726 patients; p = 0.19). T- patients treated >2 h after onset suffered higher mortality (20/196 patients; 10.2%) than T+ patients (100/1,836 patients; 5.4%; p = 0.01). Multivariate analysis of the data on patients treated >2 h after onset demonstrated T- waves to be associated with mortality (OR 1.86; 95% CI 1.07-3.25; p = 0.017). T- waves in leads with ST elevation upon admission are associated with adverse prognosis in patients presenting >2 h after symptom onset, whereas in patients presenting </=2 h after first symptoms, T- waves may be associated with better prognosis.
authors.affiliation: Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Herz
authors.forename: Y
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: B
authors.initials: B
authors.lastname: Zlotikamien
authors.forename: B
authors.initials: B
authors.lastname: Strasberg
authors.forename: S
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
authors.forename: G S
authors.initials: GS
authors.lastname: Wagner
authors.forename: G I
authors.initials: GI
authors.lastname: Barbash
mesh_terms: D003955:Diagnostic Tests, Routine / Q000592:standards*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents