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Clin. Cardiol. 24, 107–113 (2001)
Hiromi Ando, M.D., Masayuki Yotsukura, M.D., Konomi Sakata, M.D., Hideaki Yoshino, M.D., Kyozo Ishikawa, M.D., FACC
Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
Summary
Background: Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI.
Hypothesis: The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI.
Methods: Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death.
Results: In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1.
Conclusion: Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.
Key words: electrocardiogram, myocardial infarction, prognosis, negative T wave, high voltage, ST-segment depression
Address for reprints:
Kyozo Ishikawa, M.D.
Second Department of Internal Medicine
Kyorin University School of Medicine
6-20-2 Shinkawa, Mitaka
Tokyo 181-8611, Japan
Received: January 4, 2000
Accepted with revision: April 18, 2000