Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate

Background Recent studies have reported that negative T waves in the settin g of acute coronary events are associated with Thrombolysis In Myocardial I nfarction flow grade 3 in the infarct-related artery and with improved para meters of ventricular function rather than with ischemia. Methods Patients enrolled in the Global Utilization of Streptokinase and Ti ssue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiogr aphic substudy (ie, patients with acute infarction randomly assigned to one of 4 thrombolytic regimens who then underwent coronary angiography) were i ncluded in this study if they survived at least 24 hours and had no confoun ding electrocardiographic factors (n = 1505). Results More patients had negative T waves develop (NT group, n = 938 [62%] ) than not (PT group, n = 567 [38%]). Peak creatine kinase MB, time to thro mbolysis, and randomization to accelerated alteplase were no different betw een the groups. Thirty days after admission, 12 patients in the NT group ha d died versus 25 patients in the PT group (1.3% vs. 4.4%; P < .001; odds ra tio for negative T waves 0.28; 95% confidence interval 0.14-0.56). The diff erence persisted when only patients who survived at least 3 days were analy zed. After adjusting for relevant covariates (including presence of new Q w aves in the follow-up electrocardiogram), negative T waves were an independ ent predictor for survival (P = .007; odds ratio For negative T waves 0.38; 95% confidence interval 0.18-0.78). Patients in the NT group were 35% more likely to have achieved patency of the infarct-related artery, although th is difference was not statistically significant. Conclusions Negative T waves shortly after acute myocardial infarction trea ted with thrombolysis were markers for improved 30-day survival rate. This finding merits prospective testing.