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.
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Article info
Publication history
Accepted:
May 5,
2009
Received in revised form:
May 5,
2009
Received:
March 18,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
