Circulation, Vol 73, 1186-1198, Copyright © 1986 by American Heart Association
RS Gibson, GA Beller, M Gheorghiade, TW Nygaard, DD Watson, BL Huey, SL Sayre and DL Kaiser
Despite having smaller infarct size and better left ventricular function,
patients with non-Q wave myocardial infarction (NQMI) appear to have an
unexpectedly high long-term mortality that is ultimately comparable to that
of patients with Q-wave myocardial infarction (QMI). Patients with NQMI may
lose their initial prognostic advantage because there is more viable tissue
in the perfusion zone of the infarct- related vessel, rendering myocardium
more prone to reinfarction. We tested this hypothesis in a prospective
study of 241 consecutive patients 65 years of age or younger with acute
uncomplicated myocardial infarction confirmed by creatine kinase levels (MB
fraction). All patients received customary care and none underwent
thrombolytic therapy or emergency angioplasty. Predischarge coronary
angiography, radionuclide ventriculography, 24 hr Holter monitoring, and
quantitative thallium-201 (201T1) scintigraphy during treadmill exercise
were performed 10 +/- 3 days after infarction. Infarcts were designated as
QMI (n = 154) or NQMI (n = 87) by accepted criteria applied to serial
electrocardiograms obtained on days 1, 2, 3, and 10. The baseline Norris
coronary prognostic index, angiographic jeopardy scores, and prevalence of
Lown grade ventricular arrhythmias were similar between groups despite
evidence for less necrosis with NQMI vs QMI, reflected by lower peak
creatine kinase levels (520 vs 1334 IU/liter; p = .0001, 4 hr sampling),
higher resting left ventricular ejection fraction (53% vs 46%; p = .0001),
fewer akinetic or dyskinetic segments (1.2 vs 2.4; p = .0001), and fewer
persistent 201Tl defects in the infarct zone (0.9 vs 1.9; p = .0001).
Patients with NQMI also had more patent infarct-related vessels (54% vs
25%; p less than .0001) and a shorter time from onset of infarction to peak
creatine kinase level (16.9 vs 22.5 hr; p = .0001). Importantly, the
prevalence and extent of quantitatively determined 201Tl redistribution
within the infarct zone on exercise scintigraphy was greater in patients
with NQMI vs those with QMI (60% vs 36%, p = .007; and 0.98 vs 0.53
myocardial segments, p = .0003); when the two groups were stratified on the
basis of the infarct-related vessel, subset analysis revealed the same
findings. During 30 months median follow-up, cardiac mortality was low,
8.4% in the QMI group and 9.2% in the NQMI group (p = NS).(ABSTRACT
TRUNCATED AT 400 WORDS)
ARTICLES
The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study
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