The prognostic implications of negative T waves in the leads with ST segment elevation on admission in acute myocardial infarction

Cardiology. 1999;92(2):121-7. doi: 10.1159/000006959.


We assessed the prognostic significance of negative T waves on admission in leads with ST elevation in 2,853 patients with acute myocardial infarction treated with thrombolysis. Patients were classified into 2 groups based on the presence of negative (T-) or positive (T+) T waves in the leads with ST elevation on admission. T+ and T- waves on admission were detected in 2,601 (91%) and 252 (9%) patients, respectively. T- waves were observed in 6.7 and 9.6% of patients admitted </=2 and 2-6 h after onset of infarction, respectively. There was a difference in prognosis between patients admitted </=2 and >2 h after symptom onset. T- patients admitted </=2 h after onset had no hospital mortality (0/52 patients), as compared to a 5.0% mortality rate in T+ patients (36/726 patients; p = 0.19). T- patients treated >2 h after onset suffered higher mortality (20/196 patients; 10.2%) than T+ patients (100/1,836 patients; 5.4%; p = 0.01). Multivariate analysis of the data on patients treated >2 h after onset demonstrated T- waves to be associated with mortality (OR 1.86; 95% CI 1.07-3.25; p = 0.017). T- waves in leads with ST elevation upon admission are associated with adverse prognosis in patients presenting >2 h after symptom onset, whereas in patients presenting </=2 h after first symptoms, T- waves may be associated with better prognosis.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Diagnostic Tests, Routine / standards*
  • Electrocardiography / methods*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology*
  • Myocardial Infarction / therapy
  • Predictive Value of Tests
  • Prognosis
  • Time Factors
  • Treatment Outcome


  • Fibrinolytic Agents