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European Heart Journal 2002 23(18):1449-1455; doi:10.1053/euhj.2002.3263
Copyright © 2002 by the European Society of Cardiology.
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Slowed ST segment recovery despite early infarct artery patency in patients with Q waves at presentation with a first acute myocardial infarction. Implications of initial Q waves on myocyte reperfusion

C.-K. Wonga, J.K. Frencha, M.W. Krucoffb, W. Gaoa, P.E. Aylwardc and H.D. Whitea,f1

a Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand
b Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
c Flinders Medical Centre, Adelaide, South Australia

revised April 9, 2002; accepted April 10, 2002

Abstract

Background The presence of Q waves at presentation with a first acute myocardial infarction reflects a more advanced stage of the infarction process. When infarct-related artery patency (Thrombolysis in Myocardial Infarction 2 or 3 flow) is restored, resolution of ST segment elevation indicating successful myocyte reperfusion may differ according to how far the infarction process has progressed.

Methods and Results In 144 patients with a first acute myocardial infarction treated with streptokinase in the first Hirulog Early Reperfusion Occlusion trial, information was obtained from continuous ST segment monitoring, the presenting electrocardiogram and early angiography performed at a median time of 99min after the commencement of streptokinase (interquartile range 89–108min). We determined how many patients had 50% ST recovery within 120min and in how many cases it was sustained over 4h. In the 109 patients with patent infarct-related arteries, 50% ST recovery occurred in 95% of patients without vs 80% of those with initial Q waves (P=0·03), and sustained ST recovery occurred in 67% of patients without vs 47% of those with initial Q waves (P=0·03). On multivariate analysis including the time from symptom onset to streptokinase therapy, the presence of Q waves at presentation was the only predictor of failure to achieve 50% ST recovery (odds ratio 5·08, 95% confidence interval 1·29–20·01, P=0·02). TIMI 2 flow, as opposed to TIMI 3 flow, was the only predictor of failure to achieve stable ST recovery (odds ratio 2·63, 95% confidence interval 1·15–5·88,P =0·02).

Conclusion The presence of initial Q waves predicts slower and less complete ST recovery, reflecting reduced myocyte reperfusion, even in those with early infarct artery patency. These patients may be targeted for new therapeutic strategies to improve microvascular reperfusion. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Q waves, ST recovery

f1 Correspondence: Prof. Harvey D. White, DSc, FESC, Director of Cardiovascular Research, Department of Cardiology, Green Lane Hospital, Epsom, Auckland 3, New Zealand.

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C.-K. Wong, W. Gao, R. A.H. Stewart, N. van Pelt, J. K. French, P. E.G. Aylward, H. D. White, and on behalf of the Hirulog Early Reperfusion Occlusi
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