PROGNOSTIC VALUE OF PATHOLOGIC Q-WAVE AND TIME OF ITS APPEARANCE IN PATIENTS WITH MYOCARDIAL INFARCTION: COMPARISON STUDY
https://doi.org/10.20996/1819-6446-2010-6-6-812-817
Abstract
Aim. To evaluate short- and long-term prognosis of myocardial infarction (MI) depending on occurrence of pathologic Q-wave on ECG and time of its appearance.
Material and methods. 616 patients with initial ST-elevated MI were included into the study — 254 women and 362 men, aged 62.1±11.2. All patients were split up three groups depending on occurrence of pathologic Q-wave on ECG and time of its appearance. First group consisted of 311 patients with early Q-wave (during first 6 hours from onset of MI symptoms). Second group consisted of 120 patients with late Q-wave (from 6 to 24 hours from onset of MI symptoms). Third group consisted of 185 patients with non-Q-wave MI.
Results. The hospital lethality in the patients with early Q-wave was significantly higher than this in patients of the second and the third groups. However, we didn’t reveal significant differences between patients with late Q-wave and patients without Q-wave on ECG. The incidences of cardiac death (sudden death and fatal MI), non-fatal MI and hospitalization because of unstable angina was assessed during next two years. During the follow-up period patients of three groups had similar incidences of the non-fatal MI and hospitalization because of unstable angina. However, incidence of cardiac death was significantly higher in early Q-wave group in comparison with non-Q-wave group.
Conclusion. Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of MI.About the Authors
V. A. Shulman
Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
S. E. Golovenkin
Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
V. N. Simulin
City Clinical Hospital №20 named after I.S. Berzon
Russian Federation
Instrumentalnaya ul 12, Krasnoyarsk, 660014
Russian Federation
Instrumentalnaya ul 12, Krasnoyarsk, 660014
V. V. Radionov
City Clinical Hospital №20 named after I.S. Berzon
Russian Federation
Instrumentalnaya ul 12, Krasnoyarsk, 660014
Russian Federation
Instrumentalnaya ul 12, Krasnoyarsk, 660014
G. V. Matyushin
Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
Russian Federation
Partizana Zheleznyaka ul. 1, Krasnoyarsk, 660022
References
1. Prinzmetal M., Shaw C.M. Jr., Maxwell M.H. et al. Studies on the mechanism of ventricular activity.VI. The depolarization complex in pure subendocardial infarction:role ofthe subendocardial region in the normal electrocardiogram. Am J Med 1954;16(4):469–488.
2. Herlitz J., Hjalmarson A., Bengtsson A., Sillfors L. Long-term prognosis in relation to ECG findings in acute myocardial infarction. Acta Cardiol 1987;42(2):79–89.
3. Goldberg R.J., Gore J.M., Alpert J.S., Dalen J.E. Non-Q wave myocardial infarction: recent changes in occurrence and prognosis--a community-wide perspective. Am Heart J 1987;113(2 Pt 1):273–279.
4. Goodman S.G., Barr A., Langer A. et al. Development and prognosis of non-Q-wave myocardial infarction in the thrombolytic era. Am Heart J 2002;144(2):243–250.
5. Barbagelata A., Califf R.M., Sgarbossa E.B. et al. Use of resources, quality of life, and clinical outcomes in patients with and without new Q waves afterthrombolytic therapy for acute myocardial infarction (from the GUSTO-I trial). Am J Cardiol 2000;86(1):24–29.
6. Tomoda H., Aoki N. Pathophysiology of early coronary angioplasty with stenting on non Q-wave vs Q-wave myocardial infarction. Angiology 2001;52(10):671–679.
7. Gibson R.S. Non-Q-wave myocardial infarction: pathophysiology, prognosis, and therapeutic strategy. Annu Rev Med 1989;40:395–410.
8. Goodman S.G., LangerA., RossA.M. et al. Non-Q-wave versus Q-wave myocardial infarction after thrombolytic therapy: angiographic and prognostic insights from the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries-I angiographic substudy. GUSTO-I Angiographic Investigators. Circulation 1998;97(5):444- 450.
9. Edlavitch S.A., Crow R., Burke G.L., BaxterJ. Seculartrends in Q wave and non-Q wave acute myocardial infarction. The Minnesota Heart Survey. Circulation 1991;83(2):492–503.
10. Behar S., Haim M., Hod H. et al. Long-term prognosis of patients after a Q wave compared with a non-Q wave first acute myocardial infarction. Data from the SPRINT Registry. Eur Heart J 1996;17(10):1532–1537.
11. Andrews J., French J.K., Manda S.O., White H.D. New Q waves on the presenting electrocardiogram independently predict increased cardiac mortality following a first ST-elevation myocardial infarction. Eur Heart J 2000;21(8):647–653.
12. Barbagelata A., Califf R.M., Sgarbossa E.B. et al. Thrombolysis and Q wave versus non Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Strep tokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators. J Am Coll Cardiol 1997;29(4):770–777.
13. Furman M.I., DauermanH.L., Goldberg R.J. et al. Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non Q-wave myocardial infarction: a multi-hospital, community-wide perspective. J Am Coll Cardiol 2001;37(6):1571–1580.
14. Qian Y.J., Wang J.H., Tao H.L. et al. Acute non-Q-wave myocardial infarction and its clinicopathological correlation. A long-term follow-up of 21 cases. Chin Med J (Engl) 1990;103(12):995–997.
15. Gibson R.S. Clinical, functional, and angiographic distinctions between Q wave and non Q wave myocardial infarction: evidence of spontaneous reperfusion and implications for intervention trials. Circulation 1987;75(6 Pt 2):V128–138.
16. Herlitz J.,HjalmarsonA., Karlson B.W. Prognosis during one yearfor patients with myocardial infarction in relation to the development of Q waves: experiences from the Miami trial. Clin Cardiol 1990;13(4):261–264.
17. Karlson B.W., Herlitz J., Richter A., Hjalmarson A. Prognosis in acute myocardial infarction in relation to development of Q waves. Clin Cardiol 1991;14(11):875–880.
18. Matetzky S., Barabash G.I., Rabinowitz B. et al. Q wave and Non-Q wave myocardial infarction after thrombolysis. J Am Coll Cardiol 1995;26(6):1445–1451.
19. Berger C.J., Murabito J.M., Evans J.C. et al. Prognosis afterfirst myocardial infarction. Comparison of Q-wave and non-Q-wave myocardial infarction in the Framingham Heart Study. JAMA 1992;268(12):1545–1551.
20. Caires G., Pereira D., Freitas A.D. et al. Survival analysis within one year of first acute myocardial infarction: comparison between non-Q and Q wave myocardial infarction. Rev Port Cardiol 2000;19(12):1223–1238.
21. Gunnar R.M., Bourdillon P.D., Dixon D.W. et al. ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (subcommittee to develop guidelines for the early management of patients with acute myocardial infarction). Circulation 1990;82(2):664- 707.
22. Ryan T.J., Anderson J.L., Antman E.M. et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996;28(5):1328–419.
23. Phibbs B.P. The Q wave infarct; phenomenon or chimera? Eur HeartJ 2001;22(12):980– 982.
24. Phibbs B., Marcus F.I. Perpetuation of the myth of the Q-wave versus the non–Q-wave myocardial infarction. J Am Coll Cardiol 2002;39(3):556–557.
25. Phibbs B., Marcus F., Marriott H.J. et al. Q-wave versus non-Q wave myocardial infarction: a meaningless distinction. J Am Coll Cardiol 1999;33(2):576–582.
26. Moon J.C., De Arenaza D.P., Elkington A.G. et al. The pathologic basis of Q-wave and non Q-wave myocardial infarction: a cardiovascular magnetic resonance study. J Am Coll Cardiol 2004;44(3):554–560.
27. Kaandorp T.A., Bax J.J., LambH.J. et al. Which parameters on magnetic resonance imaging determine Q waves on the electrocardiogram? Am J Cardiol 2005;95(8):925–929.
28. LaBounty T., Gurm H.S., Goodman S.G. et al. Predictors and Implications of Q-Waves in ST-Elevation Acute Coronary Syndromes. Am J Med 2009;122(2):144–151.
29. Halkin A., Fourey D., Roth A. et al. Incidence and prognosis of non-Q-wave vs. Q-wave myocardial infarction following catheter-based reperfusion therapy. QJM 2009;102(6):401-406.
Review
For citations:
Shulman V.A., Golovenkin S.E., Simulin V.N., Radionov V.V., Matyushin G.V. PROGNOSTIC VALUE OF PATHOLOGIC Q-WAVE AND TIME OF ITS APPEARANCE IN PATIENTS WITH MYOCARDIAL INFARCTION: COMPARISON STUDY. Rational Pharmacotherapy in Cardiology. 2010;6(6):812-817. (In Russ.) https://doi.org/10.20996/1819-6446-2010-6-6-812-817
Views:
701
Email this article 