Key result
The presence of both Q waves and T-wave inversion on the admission ECG in STEMI patients predicted the highest 30-day and one-year mortality, while their absence predicted the lowest mortality.
Why the study?
Does the presence of Q waves and T-wave inversion on admission ECG predict 30-day and one-year mortality in patients with STEMI?
Cohort (n=627)
Does the presence of Q waves and T-wave inversion on admission ECG predict 30-day and one-year mortality in patients with STEMI?
Combining Q wave and T-wave inversion analysis on admission ECG improves risk stratification in STEMI patients, with the presence of both indicating the highest mortality risk.
Q waves plus T-wave inversion on admission ECG identify highest-risk STEMI patients; hypothesis-generating for refined risk models pending prospective validation.
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.
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Koivula et al. (2018) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=627). Q waves and T-wave inversion (TWI) on admission ECG vs. Absence of Q waves and TWI was evaluated on 30-day and one-year mortality. The presence of both Q waves and T-wave inversion on the admission ECG in STEMI patients predicted the highest 30-day and one-year mortality, while their absence predicted the lowest mortality.
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