Investigating predictive value of Q-waves and inverted T-waves in anterior STEMI patients undergoing primary PCI: a prospective cohort study

Abstract

This study investigated the prognostic role of pathological Q waves and T-wave inversions (TWI) in patients with anterior ST-elevation myocardial infarction (STEMI). Prospective cohort study of 658 anterior STEMI patients undergoing primary percutaneous coronary intervention (PCI) was conducted. Participants were divided into four categories based on the presence of pathological Q waves and TWI presence on initial ECGs: Q + TWI+ ( n = 34), Q + TWI- ( n = 132), Q-TWI+ ( n = 81), and Q-TWI- ( n = 411). The primary endpoint was a composite outcome, which includes cardiovascular death, newly developed or aggravated New York Heart Association (NYHA) class IV heart failure, recurrent myocardial infarction, and cardiogenic shock. The secondary outcome was all-cause mortality, and the total study period was one year. Survival differences and hazard ratios among groups were assessed using log-rank tests and Cox regression analyses. Patients had significant baseline differences in age, gender, and clinical parameters. Survival analysis revealed significantly higher mortality risks in Q + TWI+ (aHR: 7.2, 95% CI: 1.80-28.83), Q + TWI- (aHR: 2.46, 95% CI: 1.1–5.5), and Q-TWI+ (aHR: 4.28, 95% CI: 1.31–13.89). In isolated analyses, both T-wave inversion (aHR: 3.08, 95% CI: 1.15–8.21) and Q waves (aHR: 1.99, 95% CI: 1–3.96) were independently associated with increased mortality. For secondary outcomes, only Q-TWI+ showed significantly elevated risk (aHR: 3.73, 95% CI: 1.01–13.77). In anterior STEMI patients undergoing primary PCI, Q waves predicted short-term risk, while TWI strongly associated with long-term risk; their combination conferred the highest risk. Unadjusted for door-to-PCI time, these hypothesis-generating findings may reflect ischemic duration. Ultimately, they validate prior reports in a Middle Eastern cohort and support dynamic risk stratification.