title: Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study.
abstract: BACKGROUND
  Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI.
  
  
  RESULTS
  The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84];P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4];P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12;P=0.03) and MVO (β=0.18;P=0.001) after adjusting for potential confounders.
  
  
  CONCLUSIONS
  Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.). divan.topal@gmail.com.
authors.forename: Divan Gabriel
authors.initials: DG
authors.lastname: Topal
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Kiril Aleksov
authors.initials: KA
authors.lastname: Ahtarovski
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Lars
authors.initials: L
authors.lastname: Nepper-Christensen
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Kari
authors.initials: K
authors.lastname: Saünamaki
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Kasper
authors.initials: K
authors.lastname: Kyhl
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Ali
authors.initials: A
authors.lastname: Ghotbi
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Christoffer
authors.initials: C
authors.lastname: Göransson
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Litten
authors.initials: L
authors.lastname: Bertelsen
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Dan
authors.initials: D
authors.lastname: Høfsten
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.affiliation: From the Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (D.G.T., J.L., K.A.A., L.N.-C., S.H., L.H., F.P., K.S., E.J., K.K., A.G., M.M.S., C.G., L.B., D.H., L.K., N.V., T.E.); Department of Medicine, Nykøbing F Hospital, University of Southern Denmark, Odense (P.C.); Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Germany (P.C.); and Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (M.M.S., H.K.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000200:Action Potentials; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheterization; infarction; magnetic resonance imaging; myocardium; reperfusion