Abnormal Q waves on the admission electrocardiogram of patients with first acute myocardial infarction: prognostic implications.
BACKGROUND
Q waves developed in the subacute and persisting into the chronic phase of myocardial infarction (MI) usually signify myocardial necrosis. However, the mechanism and significance of Q waves that appear very early in the course of acute MI (< 6 h from onset of symptoms), especially if accompanied by ST elevation, are probably different.


OBJECTIVE
This study assesses the prognostic implications of abnormal Q waves on admission in 2,370 patients with first acute MI treated with thrombolytic therapy < 6 h of onset of symptoms.


RESULTS
Patients with abnormal Q waves in > or = 2 leads with ST-segment elevation (n = 923) were older than patients without early Q waves (n = 1,447) (60.6 +/- 11.9 vs. 58.8 +/- 11.9 years, respectively; p = 0.0003), and had a greater incidence of hypertension (34.3 vs. 30.5%; p = 0.05) and anterior MI (60.6 vs. 41.1%; p < 0.0001). Time from onset of symptoms to therapy was longer in patients with Q waves upon admission (208 +/- 196 vs. 183 +/- 230 min; p = 0.01). Peak serum creatine kinase (2235 +/- 1544 vs. 1622 +/- 1536 IU; p < 0.0001), prevalence of heart failure during hospitalization (13.8 vs. 7.0%, p < 0.0002), hospital mortality (8.0 vs. 4.6%; p = 0.02), and cardiac mortality (6.6 vs. 4.5%, p = 0.11) were higher in patients with anterior MI and with abnormal Q waves than in those without abnormal Q waves upon admission. There was no difference in peak creatine kinase, prevalence of heart failure, in-hospital mortality, and cardiac mortality between patients with and without abnormal Q waves in inferior MI. Multivariate regression analysis confirmed that mortality is independently associated with presence of Q waves on admission (odds ratio 1.61; 95% CI 1.04-2.49; p = 0.04 for all patients; odds ratio 1.65; 95% CI 0.97-2.83; p = 0.09 for anterior wall MI.


CONCLUSIONS
Abnormal Q waves on the admission electrocardiogram (ECG) are associated with higher peak creatine kinase, higher prevalence of heart failure, and increased mortality in patients with anterior MI. Abnormal Q waves on the admission ECG of patients with inferior MI are not associated with adverse prognosis.
Birnbaum
Y
Y
Beilinson Medical Center, Petah-Tiqva, Israel.
Chetrit
A
A
Sclarovsky
S
S
Zlotikamien
B
B
Herz
I
I
Olmer
L
L
Barbash
G I
GI
D000368:Aged; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D016017:Odds Ratio; D010343:Patient Admission; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods
D005343:Fibrinolytic Agents