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.
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.


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.
Aguirre
F V
FV
St Louis University Health Sciences Center, Division of Cardiology, MO 63110, USA.
Younis
L T
LT
Chaitman
B R
BR
Ross
A M
AM
McMahon
R P
RP
Kern
M J
MJ
Berger
P B
PB
Sopko
G
G
Rogers
W J
WJ
Shaw
L
L
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D005082:Physical Exertion; D015635:Radionuclide Ventriculography; D012146:Rest; D015912:Thrombolytic Therapy; D016896:Treatment Outcome