title: Persistent negative T waves in the infarct-related leads as an independent predictor of poor long-term prognosis after acute myocardial infarction.
abstract: This study sought to determine the long-term prognostic significance of persistent or transient negative T waves in infarct-related leads. After acute myocardial infarction (AMI), QRS and T wave alterations may resolve. No clinical study has investigated the prognostic importance of persistent versus transient negative T waves. We studied 147 consecutive patients with first AMI and >/=2 negative T waves in the infarct-related leads on the electrocardiogram. One hundred twenty patients developed Q waves. Patients were followed clinically for 60 +/- 21 months. T-wave normalization was observed early (before hospital discharge) in 34 patients and late (at 4 +/- 1 months) in 65. Thirty patients had Q-wave regression. Adverse outcome occurred in 57 patients. There were 23 hard events (cardiac death in 12 patients and nonfatal AMI in 11). Patients with early or late T-wave normalization had similar event-free survival curves that diverged rapidly from that of patients with persistent negative T waves, who had a worse outcome (p <0.0001). Patients with or without Q-wave regression had similar survival curves. Using multivariate Cox regression analysis, higher end-systolic volume (hazard ratio [HR] 1.01, p = 0.007), the presence of multivessel disease (HR 3.33, p = 0.009), and persistent negative T waves (HR 2.92, p = 0.024) predicted hard events. Persistent negative T waves 4 months after first AMI were independently associated with a worse outcome, whereas Q-wave regression has no long-term prognostic importance.
authors.affiliation: Division of Cardiology, University Hospital, Liège, Belgium.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Paul L
authors.initials: PL
authors.lastname: Gérard
authors.forename: Henri E
authors.initials: HE
authors.lastname: Kulbertus
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003402:Creatine Kinase / Q000097:blood; D018572:Disease-Free Survival; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D003402:Creatine Kinase