Open AccessComparison of the prognostic role of Q waves and inverted T waves in the presenting ECG of STEMI patients
Author(s) -
Koivula Kimmo,
Nikus Kjell,
Viikilä Juho,
Lilleberg Jyrki,
Huhtala Heini,
Birnbaum Yochai,
Eskola Markku
Publication year - 2019
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12585
Subject(s) - medicine , myocardial infarction , t wave , cardiology , qt interval , electrocardiography
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.