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T-wave inversion which developed shortly after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is known to be related with reperfusion or myocardial viability and considered good prognostic predictor. However, there have been little data about the correlation between persistent T-wave inversion and clinical outcome in patients with STEMI.
We categorized patients into three group according to T-wave morphology after primary PCI: no newly developed T-wave inversion, newly developed T wave inversion but disappeared within 6 months (recovered T-wave group), newly developed T-wave inversion and persistent over 6 months (persistent T-wave group). New T-wave inversion was defined as new onset of T-wave inversion within 48 hours after primary PCI. The primary endpoint was the major adverse cardiac events (MACE) including cardiac death, myocardial infarction, target vessel revascularization and rehospitalization for heart failure.
A total 299 patients were analyzed and followed up for mean 25months. The patients with no newly developed T-wave inversion was 70, recovered T-wave with 158 and 71 patients with persistent T-wave group respectively. The cumulative MACE rate was significantly lower in patients with recovered T-wave group than no new T-wave and persistent T-wave group. (9.7% vs. 20.3% vs. 19.7%, respectively, p= 0.043). In multivariate Cox regression analysis, recovered T-wave inversion was an independent prognostic factor for MACE compared with no or persistent T-wave inversion group. (Hazard ration 0.49, 95% confidential interval 0.26-0.91, p=0.026).
Newly developed T wave inversion but disappeared within 6 months group was associated with favorable long-term outcome compared with no-newly developed T-wave inversion or persistent T-wave inversion group.
CORONARY: Acute Myocardial Infarction