Prognostic Impact of Q Waves on Presentation and ST Resolution in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

• Published in: The American journal of cardiology Vol. 104; no. 6; pp. 780 - 785
• Main Authors: Kumar, Saurabh, BSc, MBBS, Hsieh, Calvin, MBBS, Sivagangabalan, Gopal, MBBS, Chan, Hera, BMed, Ryding, Alisdair D.S., MBBS, PhD, Narayan, Arun, RN, Ong, Andrew T.L., MBBS, PhD, Sadick, Norman, MBBS, PhD, Kovoor, Pramesh, MBBS, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.09.2009; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Comparative analysis; Coronary heart disease; Creatine Kinase - blood; Disease Progression; Diseases of the cardiovascular system; Electrocardiography; Female; Heart; Heart attacks; Heart Conduction System - physiopathology; Heart Failure - etiology; Humans; Impact analysis; Male; Medical prognosis; Medical sciences; Medical treatment; Middle Aged; Multivariate Analysis; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Prognosis; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Human; Myocardial infarction; Atherectomy; Prognosis; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Stent; Percutaneous route; ST elevation; Primary; Circulatory system; Q wave; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.05.007

Q waves can develop early in infarction and indicate infarct progression better than symptom duration. ST resolution (STR) is a predictor of reperfusion success. Our aim was to assess the prognostic impact of Q waves on presentation and STR after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction. The combined end point was of mortality and adverse cardiovascular events (MACE; death, repeat myocardial infarction, or heart failure). Q waves on presentation (Q wave, n = 332; no Q wave, n = 337) was associated with significantly less mean STR, greater incidence of akinetic, dyskinetic, or aneurysmal regional wall motion, lower left ventricular ejection fraction, and worse in-hospital and 1-year MACEs (1 year 24% vs 8.2%, p <0.001). In addition, Q waves on presentation compared to no Q waves were associated with worse 1-year MACE regardless of infarct presentation in ≤3 hours, infarct location, and adequate STR (≥70%). Q waves on presentation and inadequate STR (<70%), but not symptom duration, were independent predictors of MACE by multivariable analysis (adjusted hazard ratios of 2.7 and 2.4 for Q waves and STR, respectively). Compared to group A (no Q waves on presentation with STR), patients in group B (no Q waves with inadequate STR), group C (Q waves with STR), and group D (Q waves with inadequate STR) had hazard ratios of 3.0, 3.6, and 7.7, respectively (p <0.05) for the occurrence of MACE. In conclusion, assessment of Q-wave status on presentation and STR immediately after PPCI provides a simple and early clinical predictor of outcomes in ST-elevation myocardial infarction.