Copyright © 2000 by the European Society of Cardiology.
New Q waves on the presenting electrocardiogram independently predict increased cardiac mortality following a first ST-elevation myocardial infarction
Cardiovascular Research Unit, Cardiology Department, Green Lane Hospital, Auckland, New Zealand
revised August 23, 1999; accepted August 25, 1999
Abstract
Aims The prognostic significance of pathological Q waves appearing in the acute phase of myocardial infarction has not been determined. We investigated whether new Q waves on the presenting electrocardiogram of patients with acute ST-segment elevation were independently associated with a worse outcome after a first myocardial infarction.
Methods and Results The presence or absence of new Q waves on the presenting electrocardiogram was assessed in 481 patients who presented within 4h of symptom onset and were randomized to receive either captopril or placebo within 2h of streptokinase therapy for myocardial infarction. Ventriculography was performed at 22±6 days and mortality status was obtained at a median follow-up of 5·6 years. New Q waves were associated with a lower ejection fraction (51±13% vs 61±12%, P<0·0001), a larger end-systolic volume index (37ml vs 28ml, P<0·001), and increased cardiac mortality at 30 days (7% vs 2%, P=0·01) and at follow-up (17% vs 7%, P=0·002). On multivariate analysis, age (P<0·01), new Q waves at presentation (P<0·01) and a history of angina (P=0·046) were independent predictors of cardiac mortality, whereas randomization to captopril and the time from symptom onset to streptokinase administration were not.
Conclusion New Q waves at presentation are independently associated with a worse outcome after a first myocardial infarction. The presence of new Q waves on the presenting electrocardiogram allows very early identification of patients at risk of increased cardiac mortality.
Key Words: Cardiac mortality, electrocardiogram, Q waves
f1 Correspondence: Professor Harvey White, Cardiology Department, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand. E-mail:harveyw@ahsl.co.nz
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