Study On The Significance Of Early T Wave Inversion After Acute Anterior Myocardial Infarction And It's Influence On Strategy Of PCI

[Objective] To observe recanalization of infarct-related artery in patient who early appear T wave inversion after acute anterior myocardial infarction(AMI) ,to explore the value of delayed Percutaneous Coronary Intervention(PCI) in different T wave appearance of AMI without primary percutaneous coronary intervention.[Methods] 69 patients with initial acute anterior ST-elevation myocardial infarction hospitalized admitted within l-7days after the symptom onset during may 2007 to november 2008 were included in our study, they weren't underwent PPCI in 12 hours。We based on whether the patients' ECG showed that≥2 relative leads had negative T waves 48 hours after the onset, the patients were divided in two groups according to the ECG changes:T wave inversion group (37 cases) and positive-T-waved group(32 cases ). Collect the clinical data ,two dimensional echocardiogram was performed to recorded the index of heart function(EF ejection fraction ,LVEDD left ventricular end-diastolic dimension ,WMI wall motion index) .All patients received coronary angiography in 10-14 days after AMI onset,contrast the recanalization of infarct-related coronary artery,prove the early T wave inversion is a clinical index for estimating coronary recanalization. Revascularization was performed according to coronary,major adverse cardiac events were recorded during the follow up period(12 months),ultrasoundcardiogram was used again to observe the indexe's changes of heart function ,contrast parameters of LV function and clinical events in different phase and matched groups,indirectly reflect effectiveness of delayed PCI.[Results] the recanalization rate of IRA in negative-T-waved group was obviously higer than positive-T-waved group ;the LV ejection fraction was also higher than positive-T-wave group;but LV end-diastolic dimension ,wall motion index was lower than positive-T-waved group;the rate of adverse cardiac events was decreased,the proportion of patients who's heart function worse than NYHA III is lower.[Conclusion] T wave inversion which occurs within 48 hours in AMI patients(no matter it occur after thrombolysis or spontaneous recanalization)could be regarde as an indirect index of coronary reperfusion, for patients who haven't underwent primary PCI in best therapeutic window, delayed PCI for revascularization in patients of early T-wave inversion has higher significance than non-T-wave inversion,because the patients of early T-wave inversion has more viable myocardium.