From The Terrence Donnelly Heart Centre, Division of Cardiology, St
Michael's Hospital, University of Toronto, Toronto, Canada (S.G.G.,
A.L.); Duke University Medical Center, Durham, NC (N.M.W., G.S.W., C.B.G.,
R.M.C.); George Washington University Medical Center, Washington, DC (A.M.R.);
Favaloro Institute, Buenos Aires, Argentina (A.B.); Cleveland Clinic
Foundation, Cleveland, Ohio (E.B.S., E.J.T.); Thorax Center, Rotterdam, The
Netherlands (M.L.S.); and Department of Medicine, University of Alberta,
Edmonton, Canada (P.W.A.).
Correspondence to Shaun G. Goodman, MD, St Michael's Hospital, Division of Cardiology, 30 Bond St, Room 7–049 Queen, Toronto, Ontario, Canada M5B 1W8. E-mail goodmans{at}smh.toronto.on.ca
Background—Although the
stratification of patients with myocardial infarction into ECG subsets
based on the presence or absence of new Q waves has important clinical
and prognostic utility, systematic evaluation of the impact of
thrombolytic therapy on the subsequent development and
prognosis of non–Q-wave infarction has been limited to date.
Methods and Results—We examined 12-lead ECG, coronary
anatomy, left ventricular function, and mortality
among 2046 patients with ST-segment elevation infarction from the
Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Coronary Arteries
angiographic subset to gain further insight into the pathophysiology
and prognosis of Q- versus non–Q-wave infarction in the
thrombolytic era. Non–Q-wave infarction developed in
409 patients (20%) after thrombolytic therapy.
Compared with Q-wave patients, non–Q-wave patients were more likely to
present with lesser ST-segment elevation in a nonanterior location.
The infarct-related artery in non–Q-wave patients was more likely to
be nonanterior (67% versus 58%, P=.012) and distally
located (33% versus 39%, P=.021). Early (90-minute,
77% versus 65%, P=.001) and complete (54% versus
44%, P<.001) infarct-related artery patency was
greater among the non–Q-wave group. Non–Q-wave patients had better
global (ejection fraction, 66% versus 57%; P<.0001)
and regional left ventricular function (10 versus 24
abnormal chords, P=.0001). In-hospital, 30-day, 1-year,
and 2-year (6.3% versus 10.1%, P=.02) mortality rates
were lower among non–Q-wave patients.
Conclusions—The excellent prognosis among the subgroup of
patients who develop non–Q-wave infarction after
thrombolysis is related to early, complete, and
sustained infarct-related artery patency with resultant limitation of
left ventricular infarction and dysfunction.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
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
Key Words: infarction • electrocardiography • thrombolysis • catheterization • prognosis
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