title: The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction.
abstract: BACKGROUND
  The terminal part of the QT interval (T peak to T end; Tp-e)-an index for dispersion of cardiac repolarization-is often prolonged in patients experiencing malignant ventricular arrhythmias after acute myocardial infarction (AMI). We wanted to explore whether high Tp-e might predict mortality or fatal arrhythmia post-AMI.
  
  
  METHODS
  Tp-e was measured prospectively in 1359/1384 (98.2%) consecutive patients with ST elevation (n = 525) or non-ST elevation (n = 859) myocardial infarction (STEMI or NSTEMI) admitted for coronary angiography.
  
  
  RESULTS
  Tp-e was significantly correlated with age, heart rate (HR), heart failure, LVEF, creatinine, three-vessel disease, previous AMI and QRS and QT duration. During a mean follow-up of 1.3 years (range 0.4-2.3),109 patients (7.9%) died; 25, 45, and 39 from cardiac arrhythmia, nonarrhythmic cardiac causes and other causes, respectively. Long Tp-e was strongly associated with increased risk of death, and Tp-e remained a significant predictor of death in multivariable Cox analyses (RR 1.5, 95% CI[1.3-1.7]). HR-corrected Tp-e (cTp-e) was the strongest predictor of death (RR 1.6 [1.4-1.9]). Tp-e and cTp-e were particularly strong predictors of fatal cardiac arrhythmia (RR 1.6 [1.2-2.1] and RR 1.8 [1.4-2.4]). Findings were similar in STEMI and NSTEMI. When comparing two methods for measuring Tp-e, one including the tail of the T wave and one not, the former had markedly higher predictive power (P < 0.001).
  
  
  CONCLUSIONS
  Tp-e, and in particular cTp-e, were strong predictors of mortality during the first year post-AMI, and should be further evaluated as prognostic factors additional to established post-AMI risk factors.
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway. gunnar.erikssen@rikshospitalet.no
authors.forename: Gunnar
authors.initials: G
authors.lastname: Erikssen
authors.forename: Knut
authors.initials: K
authors.lastname: Liestøl
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: Kristina H
authors.initials: KH
authors.lastname: Haugaa
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bendz
authors.forename: Jan P
authors.initials: JP
authors.lastname: Amlie
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D009664:Norway / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D003404:Creatinine