Microvolt T-wave alternans predicts cardiac events after acute myocardial infarction in patients treated with primary percutaneous coronary intervention

ABSTRACTBackgroundCurrent risk stratification after acute myocardial infarction (MI) depends on left ventricular ejection fraction. Microvolt T-wave alternans (MTWA) is one of promising markers to predict cardiac events in patients after acute MI treated according to current guidelines.MethodsIn this single center study, 112 consecutive patients with the first anterior ST-elevation MI undergoing PCI <12 hours from symptom onset, were enrolled prospectively. Demographics, established risk factors, myocardial contrast echocardiography (MCE) perfusion, index event data and MTWA were assessed. Composite cardiac events (CCE) defined as: death, recurrent MI, sustained ventricular tachycardia (sVT) or readmission for acute heart failure (HF) were recorded during follow-up.ResultsMTWA test was negative in 76, positive in 18 and undetermined in 7 patients. MTWA negative patients had significantly higher LVEF at 30 days. At 4 years, 26 patients experienced CCE (10 died, 2 reinfarcted and 14 HF events). In multivariate Cox proportional hazard model maximum CKMB, non-negative MTWA and reduced LVEF made the best model to predict CCE. Four year CCE free survival was 77% and was significantly lower for non-negative MTWA (94% vs 50%, p<0.003).ConclusionsNon-negative MTWA with infarct size index and reduced LVEF could predict cardiac events in patients with anterior STEMI treated with primary PCI. MTWA non-negative patients have significantly worse outcome.