(Circulation. 1995;91:2541-2548.)
© 1995 American Heart Association, Inc.
Articles |
Early and 1-Year Clinical Outcome of Patients' Evolving Non–Q-Wave Versus Q-Wave Myocardial Infarction After Thrombolysis
Results From the TIMI II Study
From St Louis University Health Sciences Center (F.V.A., L.T.Y., B.R.C., M.J.K.), St Louis, Mo; Maryland Medical Research Institute (R.P.M., G.K.), Baltimore, Md; Mayo Clinic (P.B.B.), Rochester, Minn; University of Alabama (W.J.R.) (Birmingham); George Washington University (A.M.R.), Washington, DC; National Heart, Lung, and Blood Institute (G.S.), Bethesda, Md; Duke University (L.S.), Durham, NC, and Harvard Medical School (E.B.), Boston, Mass.
Correspondence to Frank V. Aguirre, MD, St Louis University Health Sciences Center, Division of Cardiology, 3635 Vista Ave at Grand Blvd, St Louis, MO 63110.
Background There are few data comparing clinical outcome and potential indications for routine post–myocardial infarction cardiac catheterization and revascularization of patients who sustain a non–Q-wave versus Q-wave infarct after thrombolytic therapy.
Methods and Results A secondary analysis of 2634 patients enrolled in the TIMI II trial with a first myocardial infarction was performed to determine 6-week and 1-year cardiac event rates and identify clinical and angiographic differences between the 1867 patients (70.9%) who evolved a Q-wave infarct and the 767 patients (29.1%) who sustained a non–Q-wave infarct after treatment with intravenous thrombolytic therapy. Male sex (85.3% versus 75.6%; P<.001) and anterior wall infarcts (53.8% versus 43.7%; P<.001) were more frequent in the Q-wave versus the non–Q-wave group. During recombinant tissue-type plasminogen activator (rTPA) infusion, a greater percentage of non–Q-wave patients (37.3% versus 23.5%; P=.001) had normalization of initial ST-segment elevation. Infarct-related artery patency (TIMI flow grade 2 or 3) (P=.02), complete infarct-related artery reperfusion (TIMI 3 flow grade) (P<.001), and the percentage of patients with a predischarge resting left ventricular ejection fraction >55% (P<.001) were greater in the non–Q-wave group. New congestive heart failure during hospitalization developed more frequently in Q-wave patients (18.9% versus 11.6%; P<.001). After 42 days, the occurrences of reinfarction (P=.76), death (P=.76), and combined death or reinfarction (P=.43) were similar in patients assigned to the invasive or conservative postlytic management strategy, regardless of infarct type. One-year mortality was 3.4% versus 4.4% for non–Q-wave versus Q-wave infarct type, respectively (P=.25).
Conclusions Angiographic and clinical differences were observed between patients who present with initial ST-segment elevation and evolve early non–Q-wave versus Q-wave myocardial infarcts after treatment with rTPA, heparin, and aspirin. Early mortality and adverse clinical cardiac events in these patients are not significantly different after a conservative compared with an invasive treatment strategy, regardless of whether the infarct type is non–Q wave or Q wave.
Key Words: myocardial infarction • thrombolysis • non–QW infarcts • clinical trials
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