Patients with tombstoning pattern on the admission electrocardiography who have undergone primary percutaneous coronary intervention for anterior wall ST-elevation myocardial infarction: in-hospital and midterm clinical outcomes

Ann Noninvasive Electrocardiol. 2012 Oct;17(4):315-22. doi: 10.1111/j.1542-474X.2012.00524.x. Epub 2012 Aug 13.


Background: A tombstoning pattern (T-pattern) is associated with in-hospital poor outcomes patients with ST-segment elevation myocardial infarction (STEMI), but no data are available for midterm follow-up. We sought to determine the prognostic value of a T-pattern on admission electrocardiography (ECG) for in-hospital and midterm mortality in patients with anterior wall STEMI treated with primary percutaneous coronary intervention (PCI).

Methods: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T-pattern (n = 32) or non-T-pattern (n = 137) based upon the admission ECG. Follow-up to 6 months was performed.

Results: In-hospital mortality tended to be higher in the T-pattern group compared with non-T-pattern group (9.3% vs 2.1% respectively, P = 0.05). All-cause mortality was higher in the T-pattern group than non-T-pattern group for 6 month (P = 0.004). After adjusting the baseline characteristics, the T-pattern remained an independent predictor of 6-month all-cause mortality (odds ratio: 5.18; 95% confidence interval: 1.25-21.47, P = 0.02).

Conclusion: A T-pattern is a strong independent predictor of 6-month all-cause mortality in anterior STEMI treated with primary PCI. Therefore, it may be an indicator of high risk among patients with anterior wall STEMI.

MeSH terms

  • Angioplasty, Balloon, Coronary
  • Coronary Angiography / methods
  • Electrocardiography / methods*
  • Electrocardiography / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / surgery
  • Myocardial Infarction / therapy*
  • Odds Ratio
  • Percutaneous Coronary Intervention / methods*
  • Postoperative Complications / diagnosis*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stents
  • Survival Analysis
  • Treatment Outcome