The Clinical Impact of the Dynamic Morphology of T-Wave Inversion After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

T-wave inversion, which develops shortly after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), is related to reperfusion or myocardial viability. We aimed to evaluate the clinical outcome according to changes in T-wave inversion in patients with STEMI.

We categorized patients into 3 groups according to T-wave morphology after primary PCI: no newly developed T-wave inversion, newly developed T-wave inversion but resolved within 6 months (recovered T-wave), and newly developed T-wave inversion and persistent over 6 months (persistent T-wave). Newly developed T-wave inversion was defined as new-onset T-wave inversion within 48 hours after primary PCI. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), comprising cardiac death, myocardial infarction, target vessel revascularization, stroke, and re-hospitalization for heart failure.

A total of 299 patients were analyzed and followed up for a mean of 25 months. Among them, 70, 158, and 71 had no newly developed T-wave inversion, recovered inversion, and persistent inversion, respectively. The cumulative MACCE rate was significantly lower in patients with recovered inversion than in those with no or persistent inversion (10.1% vs 21.4% vs 18.3%, respectively; P=0.04). In multivariate Cox regression analysis, the no T-wave inversion group (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.0 to 4.39; P=0.05) and the persistent T-wave inversion group (HR, 1.98; 95% CI, 0.93 to 4.18; P=0.07) were associated with more frequent MACCE.

Newly developed T-wave inversion that disappears within 6 months was associated with a favorable long-term outcome compared with no newly developed or persistent T-wave inversion. (Iranian Heart Journal 2022; 23(2): 26-33)