Influencing Factors Of Preoperative Terminal T Wave Inversion On Electrocardiogram In Patients With Acute ST-Segment Myocardial Infarction And Its Relationship With Prognosis

Background and objectives:electrocardiogram(ECG)has important clinical significance for the evaluation of ST-Segment elevation myocardial infarction(STEMI)patients.At present,there are more studies on ST segment and less attention on T wave The purpose of this study was to investigate the influencing factors of early T-wave inversion at the end of ECG and its relationship with clinical prognosis in patients with acute STEMI.Methods:A retrospective analysis was performed on 478 patients who successfully undergoing primary percutaneous coronary intervention(pPCI)at Zhongshan Hospital affiliated to Dalian University from January 2010 to July 2019.1.According to the terminal T wave morphology on infarction-related leads of the first ECG in hosptial,it was divided into 343 patients in the positive terminal T wave(PTTW)group and 135 patients in the terminal T wave inversion(TTWI)group.Collecting general clinical data and coronary arteriography(CAG)data to analyze the influencing factors of T wave inversion at the end of ECG before pPCI.2.According to the direction of the terminal T wave of the ECG infarct-related leads before and after the pPCI,it is divided into three groups:135 patients had TTWI before pPCI;201 patients without initial TTWI,but had TTWI after pPCI;142 patients had persistent positive T waves(PPTW)Collecting general clinical data,Ultrasonic Cardiography(UCG)data during hospitalization,and major adverse cardiac events(MACE).MACE includes heart failure and cardiogenic death.The incidence of left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD),and MACE were compared between the three groups of patients during hospitalization.Patients were followed for a period of 1 year,and the medications during the follow-up period,UCG at 1 year,and the occurrence of adverse events within 1 year were collected.Adverse events included heart failure readmission and all-cause death.The incidence of LVEF,LVEDD and adverse events during the 1-year follow-up were compared with the three groups.A total of 188 patients with anterior wall myocardial infarction were followed up,including 62 patients in the TTWI group before pPCI,89 patients in the TTWI group after pPCI,and 37 patients in the PPTW group.The follow-up UCG results and clinical prognosis were followed.Perform subgroup analysisResults:1.Influencing factors of TTWI in ECG infarction-related leads before pPCI:Compared with the PPTW group,in terms of age,hypertension,diabetes,smoking,Cr,UA,Glu,TG,HDL-C,pre-infarction angina,chest pain duration,multivessel disease,the wall of mycardial infarction and Infarct-related artery(IRA)were no significant differences(P>0.05).The patients in the TTWI group had a female patient ratio(33.3%vs 22.2%,P=0.011),an average TC level(4.96±1.19mmol/1 vs 4.55±0.91 mmol/1,P=0.001),an average LDL-C level(3.04±1.08mmol/1 vs 2.67±0.74 mmol/1,P=0.001),Proportion of cardiac insufficiency(32.6%vs 23.3%,P=0.037),good collateral circulation(17%vs 6.12%,P<0.001),the rate of IRA spontaneous perfusion before pPCI(29.6%vs 11.1%,P<0.001)and other aspects are higher than the PTTW group.The univariate correlation analysis results showed that:female patient ratio(r=0.116,P=0.011),TC level(r=0.135,P=0.003),LDL-C level(r=0.141,P=0.002),chest pain duration(r=0.112,P=0.014),admission with cardiac dysfunction(r=0.095,P=0.040),the collateral circulation was well opened(r=0.17,P<0.001),IRA spontaneous perfusion before pPCI(r=0.226,P<0.001)was positively correlated with the TTWI before pPCI.The covariates related to the preoperative ECG TTWI were included in the binary logistic regression analysis,and the results showed that the IRA spontaneous perfusion before pPCI[odds ratio(OR)4.269(95%confidence interval(CI)2.476-7.363,P<0.001),good collateral circulation[OR3.289(95%CI 1.649-6.559,P=0.001)],cardiac insufficiency in admission[OR1.996(95%CI 1.227-3.247,P=0.005)],female patients ratio[OR1.675(95%CI 1.033-2.715,P=0.036)]was independently related to TTWI of the ECG before pPCI in STEMI patients2.Comparison of echocardiography and clinical events in three groups of patients with preoperative ECG infarct-related lead TTWI group,postoperative ECG infarct-related leads TTWI group,and infarct-related lead PPTW group:There were no significant differences in LVEF(P=0.456),LVEDD(P=0.574),heart failure incidence(P=0.325),and cardiogenic mortality(P=0.555)during the three groups of STEMI patients during hospitalization;There were also no significant differences in 1-year LVEF(P=0.468),LVEDD(P=0.108),incidence of heart failure readmission(P=0.205),and all-cause mortality(P=0.896).Comparison of three groups of patients with anterior wall myocardial infarction in 1 year after pPCI UCG and clinical events:the PPTW group had a higher LVEDD at 1-year follow-up than the group of TTWI before pPCI(52.65±6.99mm vs 49.34±7.33mm,P=0.013)and the group of TTWI after pPCI(52.65±6.99mm vs 48.38±5.23mm,P=0.005),there was no marked difference in LVEDD between the group of TTWI before pPCI and the group of TTWI after pPCI(49.34±7.33mm vs 48.38±5.23mm,P=0.361);The LVEF at the 1-year follow-up of the PPTW group was lower than that of the group of TTWI before pPCI(49.27±8.85%vs 55.28±9.70%,P=0.002)and the group of TTWI after pPCI(49.271±8.85%vs 54.86±9.20%,P=0.002),and the the group of TTWI before pPCI in LVEF was no significant difference between the the group of TTWI after pPCI(55.28±9.70%vs 54.86±9.20%,P=0.789).The adverse clinical event results within 1 year showed that the proportion of heart failure re-admission to the PPTW group was higher than that the group of TTWI before pPCI(37.8%vs 19.4%,P=0.043)and the group of TTWI after pPCI(37.8%vs 14.6%,P=0.004).There was no marked difference in the proportion of heart failure rehospitalization between the group of TTWI before pPCI and the group of TTWI after pPCI(19.4%vs 14.6%,P=0.44);There was no significant difference in all-cause mortality among the three groups(P=0.981)Conclusions:IRA spontaneous perfusion before pPCI and good collateral circulation in the infarcted area were independently related to the ECG infarction-related TTWI in STEMI patients.Preoperative TTWI on ECG related-infarction leads to better long-term clinical prognosis in patients with anterior wall myocardial infarction undergoing successful PCI.