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.

HYPOTHESIS: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.

CONCLUSION: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.

译文

背景:Q波在亚急性中发展并持续进入心肌梗死(MI)的慢性期,通常预示着心肌坏死。但是,在急性心肌梗死过程中(症状发作后<6小时内)非常早出现的Q波的机制和意义可能不同,尤其是在伴有ST抬高的情况下。

假设:这项研究评估了Q波异常对2370例首次发生溶栓<症状发作后6小时的急性心肌梗死患者入院的预后影响。

结果 :Q波异常>或= 2导联且ST段抬高的患者(n = 923)比没有早期Q波的患者(n = 1,447)年龄大(分别为60.6 /-11.9 vs. 58.8 /-11.9岁; p = 0.0003),并且高血压的发生率更高(34.3 vs. 30.5%; p = 0.05)和前部MI(60.6 vs. 41.1%; p <0.0001)。入院Q波患者从症状发作到治疗的时间更长(208 /-196对183 /-230分钟; p = 0.01)。血清肌酸激酶峰值(2235 /-1544 vs. 1622 /-1536 IU; p <0.0001),住院期间心力衰竭的患病率(13.8 vs. 7.0%,p <0.0002),住院死亡率(8.0 vs. 4.6%; p = 0.02),并且前MI且Q波异常的患者的心脏死亡率更高(6.6 vs. 4.5%,p = 0.11),高于入院时Q波异常的患者。在有和没有异常MI下Q波的患者中,肌酸激酶的峰值,心力衰竭的患病率,院内死亡率和心源性死亡率无差异。多元回归分析证实,死亡率与入院时Q波的存在独立相关(所有患者的赔率比1.61; 95%CI 1.04-2.49; p = 0.04;比值比1.65; 95%CI 0.97-2.83; p = 0.09前壁心肌梗死

结论:入院心电图(ECG)的Q波异常与较高的肌酸激酶峰值,较高的心衰患病率以及前壁患者死亡率增加相关MI。MI低下患者入院心电图Q波异常与不良预后无关。

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