title: T wave inversions in leads with ST elevations in patients with acute anterior ST elevation myocardial infarction is associated with patency of the infarct related artery.
abstract: OBJECTIVE
  Following reperfusion therapy, early T wave inversions (TWI) have been shown to be a marker of successful reperfusion. We aimed to evaluate the relationship of TWI on the presenting ECG with spontaneous reperfusion as assessed by coronary angiography in patients with ST elevation (STE) myocardial infarction (STEMI).
  
  
  METHODS
  Data of 146 consecutive patients presenting to the St. Luke's Episcopal Hospital Emergency Department with acute STEMI undergoing primary percutaneous coronary intervention (p-PCI) between January, 2007 and October, 2010 were retrospectively analyzed. Clinical data, ECG and angiographic data were reviewed. Patients were dichotomized based on T wave morphology on the presenting ECG into 2 groups - those with TWI and those with positive T waves (PTW).
  
  
  RESULTS
  Thirty-one patients (21.2%) had TWI, while 115 (78.8%) had PTW. Sixty-four (43.8%) patients had anterior STE and 75 (51.3%) had inferior STE. Anterior STE was more likely to have TWI than non-anterior (29.7% vs. 14.6; p=0.014). By angiography, infarct related artery (IRA) patency (TIMI 2-3 flow) was seen in 45 (30.8%). TWI was more likely to be associated with IRA patency compared to PTW (51.6% vs. 25.2%; p=0.008). In patients with anterior STEMI and TWI, patent IRA was seen more frequently compared to those with PTW (68.4% vs. 20%; p<0.001). There was no association of T wave morphology and TIMI flow in patients with non-anterior STEMI. Patients presenting with stuttering symptoms were more likely to have TWI (70.4% vs. 10.2%; p <0.001) suggesting recurrent episodes of reperfusion and ischemia.
  
  
  CONCLUSIONS
  In anterior STEMI patients, TWI on the presenting ECG is associated with spontaneous reperfusion. This relationship was not found among patients with non-anterior STEMI.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Curtiss
authors.initials: C
authors.lastname: Moore
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Huang
authors.affiliation: Baylor College of Medicine, Houston, TX, USA; Texas Heart Institute, Houston, TX, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.affiliation: Baylor College of Medicine, Houston, TX, USA; Texas Heart Institute, Houston, TX, USA. Electronic address: ybirnbau@bcm.edu.
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
mesh_terms: D056988:Anterior Wall Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Acute coronary syndromes (ACS); Electrocardiogram; Primary percutaneous coronary intervention (p-PCI); ST elevation myocardial infarction (STEMI); Spontaneous reperfusion; T wave inversion; TIMI flow grade