Comparison of the prognostic role of Q waves and inverted T waves in the presenting ECG of STEMI patients. Issue 1 (6th September 2018)

• Record Type: Journal Article
• Authors: Koivula, Kimmo; Nikus, Kjell; Viikilä, Juho; Lilleberg, Jyrki; Huhtala, Heini; Birnbaum, Yochai; Eskola, Markku
• Is Part Of: Annals of noninvasive electrocardiology. Volume 24:Issue 1(2019:Jan.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-09-06
• Subjects: ECG -- Q wave -- STEMI -- T‐wave inversion; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12585
• Languages: English
• ISSNs: 1082-720X

Abstract

Abstract: Background: Both Q waves and T‐wave inversion (TWI) in the presenting ECG are associated with a progressed stage of myocardial infarction, possibly with less potential for myocardial salvage with reperfusion therapy. Combining the diagnostic information from the Q‐ and T‐wave analyses could improve the prognostic work‐up in ST‐elevation myocardial infarction (STEMI) patients. Methods: We sought to determine the prognostic impact of Q waves and TWI in the admission ECG on patient outcome in STEMI. We formed four groups according to the presence of Q waves and/or TWI (Q+TWI+; Q−TWI+; Q+TWI−; Q−TWI−). We studied 627 all‐comers with STEMI derived from two patient cohorts. Results: The patients with Q+TWI+ had the highest and those with Q−TWI− the lowest 30‐day and one‐year mortality. One‐year mortality was similar between Q−TWI+ and Q+TWI−. The survival analysis showed higher early mortality in Q+TWI− but the higher late mortality in Q−TWI+ compensated for the difference at 1 year. The highest peak troponin level was found in the patients with Q+TWI−. Conclusion: Q waves and TWI predict adverse outcome, especially if both ECG features are present. Q waves and TWI predict similar one‐year mortality. Extending the ECG analysis in STEMI patients to include both Q waves and TWI improves risk stratification.