Early changes in ventricular repolarization after thrombolytic therapy in patients with acute myocardial infarction as indicators

Objectives: To investigate the relationship between early T-wave inversion after thrombolytic therapy and the likelihood of successful epicardial coronary reperfusion. Subjects and Methods: Thrombolytic therapy was given to 195 patients with ST segment elevation due to acute anterior myocardial infarction ( AMI). Coronary angiography was performed. Receiver operating characteristic ( ROC) curve ( grade of sensitivity versus false positive) was calculated using likelihood ratio method to identify the ideal cut-off values of the ventricular repolarization variables. Results: Predictive indices showed 80% sensitivity, 83% specificity, 81% accuracy, 88% positive predictive value and 71% negative predictive value for early T-wave inversion after thrombolytic therapy. A good concordant agreement was noted between the data of coronary angiography and early T-wave inversion in the infarct-related ECG leads after thrombolysis ( kappa coefficient kappa = 0.876). Stepwise multivariate analysis revealed that early T-wave inversion after thrombolytic therapy of AMI was significantly associated with a history of preinfarction angi na, residual infarct-related coronary artery stenosis >0%, short time to thrombolytic therapy <0 min, and evening time for occurrence of thrombolysis ( p < 05). The ROC curve data analysis showed that early T-wave inversion amplitude after AMI had 87% sensitivity and 84% specificity for predicting successful reperfusion, with an ideal cut-off value of 7.2 mm, while time of T-wave inversion had 80% sensitivity and 79% specificity, with an ideal cut-off value of 120 min. Conclusion: The data indicate that early inversion of T wave after AMI is a statistically significant independent variable in predicting successful epicardial coronary thrombolysis status. Copyright (C) 2007 S. Karger AG, Basel.