Author + information
- Received May 17, 1993
- Revision received February 24, 1994
- Accepted March 24, 1994
- Published online August 1, 1994.
- Shlomi Matetzky, MD,
- Gabriel I. Barabash, MD, MPH,
- Amir Shahar, MD,
- Babeth Rabinowitz, MD, FACC,
- Shmuel Rath, MD,
- Yedael Har Zahav, MD,
- Oren Agranat, MD,
- Elieser Kaplinsky, MD, FACC and
- Hanoch Hod, MD, FACC∗
- ↵∗Address for correspondence: Dr. Hanoch Hod, The Heart Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Objectives. This study was undertaken to test the hypothesis that early inversion of T waves after thrombolytic therapy for acute myocardial Infarction predicts patency of the infarct-related artery with high Thrombolysis in Myocardial Infarction (TIMI) perfusion flow and better in-hospital outcome.
Background. Although numerous studies have demonstrated a strong association between early resolution of ST segment elevation after acute myocardial infarction and successful thrombolysis, little is known about early changes in T waves after thrombolytic therapy.
Methods. Ninety-four consecutive patients with acute myocardial infarction treated with recombinant tissue-type plasminogen activator (rt-PA) were studied with admission and predischarge radionuclide ventriculography and with coronary angiography within 72 h of admission. Patient stratification was based on the presence or absence of early (within 24 h) T wave inversion.
Results. Early T wave inversion was associated with a higher patency rate of the infarct-related artery (90% vs. 65%, p < 0.02) and less severe residual stenosis ([mean ± SD] 73 ± 27 vs. 83 ± 22, p = 0.06), and when only TIMI perfusion grade 3 was considered, the difference was even greater (77% vs. 41%, p < 0.001). Patients with early inversion of T waves had a lower peak creatine kinase value ([mean ± SD] 678 ± 480 vs. 1,076 ± 620, p < 0.01), and although a similar percent of patients with and without early T wave inversion had a normal ejection fraction (≥55%) on admission, a higher percent of patients with early inversion had a normal ejection fraction at hospital discharge (71% vs. 44%, p < 0.03). Early T wave inversion anticipated a more benign in-hospital clinical course with a lower incidence of adverse cardiac events (10% vs. 33%, p < 0.02).
Conclusions. Early inversion of T waves in patients with acute myocardial infarction treated with thrombolytic therapy suggests patency of the infarct-related artery, better perfusion grade and left ventricular function and a more benign in-hospital course.
☆ This study was supported by Boehringer, Ingelheim, Germany, who provided the recombinant tissue-type plasminogen activator.
- Received May 17, 1993.
- Revision received February 24, 1994.
- Accepted March 24, 1994.