Inverted T wave was defined as a T wave > 1 mm below the isoelectric line in two or more adjacent leads that had maximum ST-segment elevation. The determination of STEMI was done according to the fourth Universal Definition of Myocardial ischemic ECG criteria. All ECGs were reviewed by two expert cardiologist prior to PPCI. An ECG using standard method was obtained from each participant at the time of admission. Demographic characteristics, underlying clinical condition, and the duration of time from the onset of symptoms, were recorded for each participant. Informed consent was obtained from all participants. This study was approved by the ethics committee of our University. Patients with a history of previous MI or coronary artery bypass grafting (CABG), those admitted after more than 6 h of the onset of their symptoms, those having received thrombolytics prior to admission, those with left bundle branch block (LBBB), right bundle branch block (RBBB), intraventricular conduction delay (IVCD) or ventricular rhythms, and those with pacemakers or implantable cardioverter defibrillators were excluded from study. In this prospective study, patients with acute STEMI undergoing PPCI from May 2016 to May 2019 were evaluated. The aim of this study was to evaluate the association of on admission T wave inversion in the presenting ECG of acute STEMI patients undergoing PPCI with spontaneous reperfusion of the infarct related artery.
#Timi 2 flow serial#
Although ST elevation resolution more than 50% is a good marker for reperfusion in patients with at least two serial ECGs, it could not be used in patients with single ECG, presenting to emergency room with relived chest pain and 1–2 mm ST elevation and no base ECG. However, the associations between T wave inversion and angiographic findings have not yet been evaluated in large-scale studies. It was also associated with a higher patency rate of IRA and improvement in left ventricular function. A few studies have demonstrated that early T wave inversion can be regarded as a useful marker indicating spontaneous subendocardial reperfusion. have described the ECG markers of reperfusion including resolution of ST-segment elevation, altered QRS appearance, T wave changes, and reperfusion arrhythmias. However, electrocardiogram (ECG) can be used as an available, rapid, and easily interpretable tool in these situations. Due to the time limitations of cardiac interventions for STEMI patients, imaging studies or other laboratory tests could not be considered prior to PPCI for evaluation of presence of SR in infarct-related artery (IRA). However, current guidelines of AHA/ACC and ESC do not consider spontaneous reperfusion as a contraindication of PPCI or thrombolytics in patients with STEMI. Therefore, initial conservative treatment for patients with SR has been proposed and supported as a safe strategy by some previous investigations. In such cases, fibrinolytic therapy may not be advantageous in salvaging the myocardial ischemia because the culprit vessel is already partially patent and fibrinolytic therapy may enhance bleeding risk. It has been reported by some angiographic studies that 7–57% of patients with STEMI developed spontaneous reperfusion (SR) prior to PPCI. Primary percutaneous coronary intervention (PPCI) and thrombolytic therapy have been suggested as the essential therapeutic techniques in the management of patients with acute ST-elevation myocardial infarction (STEMI). In on-admission ECG of patients with anterior STEMI, concomitant inverted T wave in leads with ST elevation could be a proper marker of spontaneous reperfusion of infarct related artery. In patients with anterior STEMI and inverted T waves, a significantly higher TIMI flow was detected ( p value = 0.001) however, this relationship was not seen in non-anterior STEMI.
Among those with anterior STEMI, 62 patients (10.4%) had inverted T and 530 (89.6%) had positive T waves. Anterior STEMI was seen in 592 patients (57.7%) and non-anterior STEMI in 433 patients (42.2%).
Overall, 1025 patients were included in the study. The association between early T wave inversion and patency of the infarct-related artery was investigated in both anterior and non-anterior STEMI. ECG was obtained at the time of admission and patients underwent a PPCI. In this prospective study, patients with STEMI admitted to a tertiary referral hospital were studied over a 3-year period. Our objective was to evaluate the applicability of T wave inversion in electrocardiography (ECG) of patients with STEMI as an indicator of early spontaneous reperfusion. Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions.
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