title: Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate.
abstract: BACKGROUND
  Recent studies have reported that negative T waves in the setting of acute coronary events are associated with Thrombolysis In Myocardial Infarction flow grade 3 in the infarct-related artery and with improved parameters of ventricular function rather than with ischemia.
  
  
  METHODS
  Patients enrolled in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiographic substudy (ie, patients with acute infarction randomly assigned to one of 4 thrombolytic regimens who then underwent coronary angiography) were included in this study if they survived at least 24 hours and had no confounding electrocardiographic factors (n = 1505).
  
  
  RESULTS
  More patients had negative T waves develop (NT group, n = 938 [62%]) than not (PT group, n = 567 [38%]). Peak creatine kinase MB, time to thrombolysis, and randomization to accelerated alteplase were no different between the groups. Thirty days after admission, 12 patients in the NT group had died versus 25 patients in the PT group (1.3% vs. 4.4%; P <.001; odds ratio for negative T waves 0.28; 95% confidence interval 0.14-0.56). The difference persisted when only patients who survived at least 3 days were analyzed. After adjusting for relevant covariates (including presence of new Q waves in the follow-up electrocardiogram), negative T waves were an independent predictor for survival (P =. 007; odds ratio for negative T waves 0.38; 95% confidence interval 0. 18-0.78). Patients in the NT group were 35% more likely to have achieved patency of the infarct-related artery, although this difference was not statistically significant.
  
  
  CONCLUSIONS
  Negative T waves shortly after acute myocardial infarction treated with thrombolysis were markers for improved 30-day survival rate. This finding merits prospective testing.
authors.affiliation: Section of Cardiology, Rush-Presbyterian Medical Center, Chicago, IL 60612, USA. esgarbos@rush.edu
authors.forename: E B
authors.initials: EB
authors.lastname: Sgarbossa
authors.forename: P M
authors.initials: PM
authors.lastname: Meyer
authors.forename: S L
authors.initials: SL
authors.lastname: Pinski
authors.forename: B
authors.initials: B
authors.lastname: Pavlovic-Surjancev
authors.forename: A
authors.initials: A
authors.lastname: Barbagelata
authors.forename: S G
authors.initials: SG
authors.lastname: Goodman
authors.forename: A S
authors.initials: AS
authors.lastname: Lum
authors.forename: D A
authors.initials: DA
authors.lastname: Underwood
authors.forename: K B
authors.initials: KB
authors.lastname: Gates
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: G S
authors.initials: GS
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D017023:Coronary Angiography; D004562:Electrocardiography / Q000145:classification*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents