Prognostic Impact of Q Waves on Presentation and ST Resolution in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
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- 作者：Saurabh Kumar ; Calvin Hsieh ; Gopal Sivagangabalan ; Hera Chan ; Alisdair D.S. Ryding ; Arun Narayan ; Andrew T.L. Ong ; Norman Sadick ; Pramesh Kovoor
- 刊名：The American Journal of Cardiology
- 出版年：2009
- 出版时间：15 September 2009
- 年：2009
- 卷：104
- 期：6
- 页码：780-785
- 全文大小：298 K
文摘
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.