The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery

Abstract

Background Up to over half of the patients with ST-segment elevation myocardial infarction (STEMI) are reported to undergo spontaneous reperfusion without therapeutic interventions. 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. Methods In this prospective study, patients with STEMI admitted to a tertiary referral hospital were studied over a 3-year period. ECG was obtained at the time of admission and patients underwent a PPCI. The association between early T wave inversion and patency of the infarct-related artery was investigated in both anterior and non-anterior STEMI. Results Overall, 1025 patients were included in the study. Anterior STEMI was seen in 592 patients (57.7%) and non-anterior STEMI in 433 patients (42.2%). Among those with anterior STEMI, 62 patients (10.4%) had inverted T and 530 (89.6%) had positive T waves. 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. Conclusion 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.

Evolution of de Winter Into Wellens on Electrocardiogram—What Happened?

“…6,7 In patients who have not received reperfusion therapies, early inverted T waves were shown to be a marker of spontaneous recanalization of the culprit artery. 8 Therefore, in this case, the patient experienced the acute, typical chest pain of AMI, but it resolved spontaneously. It is possible that the transition from the de Winter to Wellens pattern was associated with spontaneous recanalization (activation of fibrinolytic system or antithrombotic therapy) after acute total occlusion of the LAD, which was followed by partial reperfusion of the myocardium, because the coronary angiography results showed 95% stenosis but not total occlusion of the LAD.…”

“…In patients with AMI who are undergoing thrombolytic therapy, studies have shown that early T wave inversion indicates a successful and effective reperfusion . In patients who have not received reperfusion therapies, early inverted T waves were shown to be a marker of spontaneous recanalization of the culprit artery . Therefore, in this case, the patient experienced the acute, typical chest pain of AMI, but it resolved spontaneously.…”

Importance of ECG in the Diagnosis of Acute Pericarditis and Myocardial Infarction: A Review Article

“…rise might be identified by an accurate indicator of spontaneous reperfusion of an infarct-related artery on the E.C.G. [37]. -segment portion from the baseline.…”

“…rise might be identified by an accurate indicator of spontaneous reperfusion of an infarct-related artery on the E.C.G. [ 37 ]. Value of the recently found T-wave inversion as a predictor in patients who have undergone first percutaneous coronary interventions and have elevated S.T.-segment MI (PCI).…”

Deteksi Myocardial Infarction Menggunakan Fitur Statistik Segmen-ST Elektrokardiogram dan Analisis Diskriminan

“…Beberapa studi ini berhubungan dengan MI, yaitu terdapat hubungan antara invers gelombang T awal dan arteri terkait dengan MI. Posisi gelombang T yang terbalik secara bersamaan pada gelombang ST dapat menjadi penanda yang tepat untuk myocardial infarction [10]. Pada studi deteksi MI yang menggunakan gelombang EKG, peningkatkan akurasi dapat dilakukan menggunakan metode Multiple Instance Learning (MIL).…”