LaBounty Troy, Gurm Hitinder S, Goodman Shaun G, Montalescot Gilles, Lopez-Sendon Jose, Quill Ann, Eagle Kim A
Weill Cornell Medical College, New York, NY, USA.
Am J Med. 2009 Feb;122(2):144-51. doi: 10.1016/j.amjmed.2008.08.029.
Q-waves in ST-elevation acute coronary syndromes carry adverse implications. We sought to determine the frequency, predictors, and implications of Q-waves in the current era that includes primary percutaneous coronary interventions.
There were 14,916 patients evaluated in a multicenter observational study. They presented with ST-elevation acute coronary syndromes between 1999 and 2006. Clinical variables were compared between patients with versus without presenting Q-waves, with an additional comparison in the latter group between those with versus without subsequent development of Q-waves.
ST-elevation myocardial infarction occurred in 88.6% of patients. Q-waves were present on the initial electrocardiogram in 3929 patients and developed later in an additional 3085 patients. The incidence of Q-waves at presentation or during hospitalization decreased from 61% to 39% between 1999 and 2006 (linear trend P<.001). Both presenting and subsequent Q-waves were associated with greater likelihood of coronary occlusions and higher cardiac marker elevations (P <.001). Multivariate analysis showed that presenting Q-waves were associated with male sex (odds ratio [OR] 1.28), increased age (OR 1.06 per 5 years), diabetes (OR 1.26), smoking (OR 1.11), chronic aspirin (OR 0.79), acute aspirin (OR 0.87), other chronic cardiac medications (OR 0.80), prior heart failure (OR 0.67), and prior coronary artery disease (OR 0.61). Presenting Q-waves were independently associated with increased in-hospital mortality (OR 1.46), but Q-waves at presentation or during hospitalization did not impact 6-month mortality.
Q-waves in ST-elevation acute coronary syndromes are decreasing in incidence. Q-waves are a major determinant of in-hospital mortality, and targeted interventions should be directed to these high-risk patients.
ST段抬高型急性冠状动脉综合征中的Q波具有不良影响。我们试图确定在包括直接经皮冠状动脉介入治疗的当前时代，Q波的发生率、预测因素及影响。
在一项多中心观察性研究中评估了14916例患者。他们于1999年至2006年间出现ST段抬高型急性冠状动脉综合征。对有Q波和无Q波的患者的临床变量进行比较，对后一组中随后出现Q波和未出现Q波的患者进行额外比较。
88.6%的患者发生了ST段抬高型心肌梗死。3929例患者初始心电图上有Q波，另有3085例患者随后出现Q波。1999年至2006年间，就诊时或住院期间Q波的发生率从61%降至39%（线性趋势P<0.001）。就诊时和随后出现的Q波均与冠状动脉闭塞的可能性增加和心脏标志物升高有关（P<0.001）。多变量分析显示，就诊时的Q波与男性（比值比[OR]1.28）、年龄增加（每5岁OR 1.06）、糖尿病（OR 1.26）、吸烟（OR 1.11）、长期服用阿司匹林（OR 0.79）、急性服用阿司匹林（OR 0.87）、其他慢性心脏药物（OR 0.80）、既往心力衰竭（OR 0.67）和既往冠状动脉疾病（OR 0.61）有关。就诊时的Q波与住院死亡率增加独立相关（OR 1.46），但就诊时或住院期间的Q波不影响6个月死亡率。
ST段抬高型急性冠状动脉综合征中Q波的发生率正在下降。Q波是住院死亡率的主要决定因素，应针对这些高危患者进行有针对性的干预。
