title: Patients with tombstoning pattern on the admission electrocardiography who have undergone primary percutaneous coronary intervention for anterior wall ST-elevation myocardial infarction: in-hospital and midterm clinical outcomes.
abstract: BACKGROUND
  A tombstoning pattern (T-pattern) is associated with in-hospital poor outcomes patients with ST-segment elevation myocardial infarction (STEMI), but no data are available for midterm follow-up. We sought to determine the prognostic value of a T-pattern on admission electrocardiography (ECG) for in-hospital and midterm mortality in patients with anterior wall STEMI treated with primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T-pattern (n = 32) or non-T-pattern (n = 137) based upon the admission ECG. Follow-up to 6 months was performed.
  
  
  RESULTS
  In-hospital mortality tended to be higher in the T-pattern group compared with non-T-pattern group (9.3% vs 2.1% respectively, P = 0.05). All-cause mortality was higher in the T-pattern group than non-T-pattern group for 6 month (P = 0.004). After adjusting the baseline characteristics, the T-pattern remained an independent predictor of 6-month all-cause mortality (odds ratio: 5.18; 95% confidence interval: 1.25-21.47, P = 0.02).
  
  
  CONCLUSIONS
  A T-pattern is a strong independent predictor of 6-month all-cause mortality in anterior STEMI treated with primary PCI. Therefore, it may be an indicator of high risk among patients with anterior wall STEMI.
authors.affiliation: Cardiology Department, School of Medicine, Balikesir University, Balikesir, Turkey. erkayh@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Ayhan
authors.forename: Turgay
authors.initials: T
authors.lastname: Isık
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
authors.forename: Gokhan
authors.initials: G
authors.lastname: Cicek
authors.forename: Servet
authors.initials: S
authors.lastname: Altay
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
authors.forename: Charles
authors.initials: C
authors.lastname: Michael Gibson
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome