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European Heart Journal 2000 21(24):2014-2025; doi:10.1053/euhj.2000.2423
Copyright © 2000 by the European Society of Cardiology.
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Early invasive versus ischaemia-guided strategies in the management of non-Q wave myocardial infarction patients with and without prior myocardial infarction. Results of Veterans Affairs Non-Q Wave Infarction Strategies In Hospital (VANQWISH) trial

P.S Heggunjea, M.J Wadea, R.A O'Rourkeb, R.E Kleigerc, P.C Deedwaniad, P.W Lavorie and W.E Bodena,f1 Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) trial investigators

a Veterans Affairs Medical Center and the State University of New York Health Science Center, Syracuse, New York, U.S.A.
b University of Texas Health Science Center at San Antonio, Texas, U.S.A.
c Washington University School of Medicine, St. Louis, Missouri, U.S.A.
d Veterans Affairs Medical Center, Fresno, California, U.S.A.
e Palo Alto VA Medical Center, Palo Alto, California, U.S.A.

revised August 15, 2000; accepted August 16, 2000

Abstract

Aims To compare the role of early invasive vs conservative management strategies in treating patients with non-Q wave myocardial infarction with or without a prior myocardial infarction.

Background In patients recovering from non-Q wave myocardial infarction, the prognosis among patients with a first non-Q wave myocardial infarction is significantly better than in patients with a prior myocardial infarction, yet physicians often adopt an early invasive strategy to treat patients with a first non-Q wave myocardial infarction.

Methods Non-Q wave myocardial infarction patients enrolled in the VANQWISH trial with a history of prior myocardial infarction were compared to those with a first non-Q wave myocardial infarction, for the trial primary end-point of death or myocardial infarction at 1 and 12 months, as well as for the initial randomized treatment strategy.

Results Of the 920 non-Q wave myocardial infarction patients, 396 had a history of prior myocardial infarction and 524 did not. Patients with a history of prior myocardial infarction were older and had a higher incidence of multiple high-risk baseline characteristics than those with a first non-Q wave myocardial infarction. Compared to the group with a first myocardial infarction, the prior myocardial infarction group suffered more events at both 1 month (11% vs 6%, P=0·007) and at 12 months (29% vs 16%, P<0·001). This difference in outcome remained significant even after adjusting for confounding variables (P<0·0001 at 12 months). Among the non-Q wave myocardial infarction patients with a prior myocardial infarction, the frequency of death or recurrent myocardial infarction was similar in both invasive and conservative groups during the first year of follow-up. Among the first non-Q wave myocardial infarction group, those assigned to the conservative strategy had significantly fewer events (3% vs 9%,P =0·009 at 1 month; 12% vs 20%, P=0·016 at 12 months) and mortality (1% vs 5%, P=0·012 at one month; 5% vs 11%, P=0·009 at 12 months) than those assigned to early invasive strategy.

Conclusion A history of prior myocardial infarction identifies a moderately high-risk subset of non-Q wave myocardial infarction patients who display similar long-term outcomes regardless of the strategy assignment; however, patients with a first non-Q wave myocardial infarction may fare better with a conservative or ischaemia-guided approach during the first post infarction year.

Key Words: Non-Q wave myocardial infarction, invasive, ischaemia-guided

f1 Correspondence: William E. Boden MD, Department of Medicine Room C-604, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210, U.S.A.

References

  1. Marmor A, Sobel BE, Roberts R. Factors presaging early recurrent myocardial infarction (‘extension’). Am J Cardiol. 1981;48:603–610[CrossRef][ISI][Medline]
  2. Nicod P, Gilpin E, Dittrich H. Short and long term clinical outcome after Q wave and non-Q-wave myocardial infarction in a large patient population. Circulation. 1989;79:528–536[Abstract/Free Full Text]
  3. Schechtman KB, Capone RJ, Kleiger RE. Differential risk patterns associated with 3 month as compared with 3 to 12 month mortality and reinfarction after non-Q wave myocardial infarction: the diltiazem Reinfarction Study Group. J Am Coll Cardiol. 1990;15:940–947[Abstract]
  4. Gibson RS. Non-Q wave myocardial infarction: diagnosis, prognosis and management. Curr Probl Cardiol. 1988;13:9–72[Medline]
  5. Fuster V, Ross R, Topol EJ. Atherosclerosis and coronary artery disease. Philadelphia: Lippincott-Raven; 1996. p. 1097–1123
  6. Circulation. 1994;89:1545–1556[Abstract/Free Full Text]
  7. Topol EJ, Califf RM, George BS. A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med. 1987;317:581–588[Abstract]
  8. JAMA. 1988;260:2849–2858[Abstract]
  9. Rouleau JL, Moye LA, Pfeffer MA. A comparison of management patterns after acute myocardial infarction in Canada and the United States. N Engl J Med. 1993;328:779–784[Abstract/Free Full Text]
  10. Boden WE, O'Rourke RA, Crawford MH. For the Veterans Affairs Non-Q-Wave Infarction Strategies In Hospital (VANQWISH) Trial Investigators. Outcomes in patients with non-Q wave myocardial infarction randomly assigned to an invasive as compared to with a conservative management strategy. N Engl J Med. 1998;338:1785–1792[Abstract/Free Full Text]
  11. Cragg DR, Friedman HZ, Bonema JD. Outcome of patients with acute myocardial infarction who are ineligible for thrombolytic therapy. Ann Int Med. 1991;115:173–177[ISI][Medline]
  12. Sahaskul Y, Chaitheraphan S, Panchivinnin P. Multivariate analysis in the prediction of death in hospital after acute myocardial infarction. Br Heart J. 1990;64:182–185[Abstract/Free Full Text]
  13. Mueller H, Forman S, Menegus M, Cohen L, Katterud G, Braunwald E. Prognostic significance of nonfatal reinfarction during three year follow up results of thrombolysis in myocardial infarction (TIMI) phase II clinical trial. J Am Coll Cardiol. 1995;26:900–907[Abstract]
  14. Benhorin J, Moss AJ, Oakes D. Prognostic significance of nonfatal myocardial reinfarction. J Am Coll Cardiol. 1990;15:253–258[Abstract]
  15. Phibbs B, Marcus F, Marriott HJC, Moss A, Spodick DH. Q-wave versus non-Q wave myocardial infarction: a meaningless distinction. J Am Coll Cardiol. 1999;33:576–582[Free Full Text]
  16. Rigo P, Murray M, Taylor D, Weisfeldt M, Strauss H, Pitt B. Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation. 1975;51:1064–1070[Abstract/Free Full Text]
  17. Gibson R, Beller G, Geoghiade M. The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study. Circulation. 1986;73:1186–1198[Abstract/Free Full Text]
  18. Cannon D, Levy W, Cohen L. The short and long term prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med. 1976;61:452–488[CrossRef][ISI][Medline]
  19. Ferry DR, O'Rourke RA, Blaustein AS. For the VANQWISH Trial Research Investigators. Design and baseline characteristics of the Veterans Affairs Non-Q-Wave Infarction Strategies In hospital (VANQWISH) trial. J Am Coll Cardiol. 1998;31:312–320[Abstract/Free Full Text]
  20. Boden WE, Kleiger RE, Gibson R. Electrocardiographic and enzymatic findings in acute non-Q wave myocardial infarction. Am J Noninvasive Cardiol. 1988;2:125–133
  21. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481[CrossRef][ISI]
  22. Cox DR. Regression models and life tables. J R Stat Soc (B). 1972;34:187–220

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