Key result
Q+TWI+ ECG pattern in STEMI linked to ~110% greater 40-day major event risk vs Q-TWI-.
Why the study?
The prognostic significance of Q waves and T-wave inversions combined and separately in STEMI patients undergoing primary PCI has not been well established.
Does the presence of Q waves and T-wave inversions on presenting ECG predict adverse outcomes in STEMI patients undergoing primary PCI?
Cohort (n=7,831)
Does the presence of Q waves and T-wave inversions on presenting ECG predict adverse outcomes in STEMI patients undergoing primary PCI?
Hazard Ratio: 2.1 (95% CI 1.45–3.04)
Absolute Event Rate: 10.5% vs 4.2%
p-value: p=<0.001
The combination of Q waves and T-wave inversions on presenting ECG in STEMI patients identifies a high-risk cohort for short-term adverse cardiovascular events.
Q waves plus TWI on presenting ECG identify higher short-term risk in STEMI; leaves open whether patterns should alter management beyond current risk stratification.
BACKGROUND: The prognostic significance of Q waves and T-wave inversions (TWI) combined and separately in STEMI patients undergoing primary PCI has not been well established in previous studies. METHODS: We included 7,831 patients from the TOTAL trial and divided the patients into categories based on Q waves and TWIs in the presenting ECG. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock or new or worsening NYHA class IV heart failure within one year. The study evaluated the effect of Q waves and TWI on the risk of primary outcome and all-cause death, and whether patient benefit of aspiration thrombectomy differed between the ECG categories. RESULTS: Patients with Q+TWI+ (Q wave and TWI) pattern had higher risk of primary outcome compared to patients with Q-TWI- pattern [33 (10.5%) vs. 221 (4.2%); adjusted hazard ratio (aHR) 2.10; 95% CI, 1.45-3.04; p<0.001] within 40-days' period. When analyzed separately, patients with Q waves had a higher risk for the primary outcome compared to patients with no Q waves in the first 40 days [aHR 1.80; 95% CI, 1.48-2.19; p<0.001] but there was no additive risk after 40 days. Patients with TWI had a higher risk for primary outcome only after 40 days when compared to patients with no TWI [aHR 1.63; 95% CI, 1.04-2.55; p=0.033]. There was a trend towards a benefit of thrombectomy in patients with the Q+TWI+ pattern. CONCLUSIONS: Q waves and TWI combined (Q+TWI+ pattern) in the presenting ECG is associated with unfavourable outcome within 40-days. Q waves tend to affect short-term outcome, while TWI has more effect on long-term outcome.
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Leivo et al. (2023) conducted a cohort in STEMI (n=7,831). Q waves and T-wave inversions (Q+TWI+ pattern) vs. No Q waves and no T-wave inversions (Q-TWI- pattern) was evaluated on Composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock or new or worsening NYHA class IV heart failure within one year (aHR 2.10, 95% CI 1.45-3.04, p=<0.001). A Q+TWI+ ECG pattern in STEMI patients increased the 40-day risk of the primary composite outcome compared to a Q-TWI- pattern (10.5% vs 4.2%; aHR 2.10; 95% CI 1.45-3.04; p<0.001).
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