Eisenberg M J, Barbash G I, Hod H, Roth A, Schachar A, Zolti L, Rabinowitz B, Kaplinsky E, Laniado S, Modan M
Cardiology Division, Moffitt-Long Hospital, University of California, San Francisco.
Am J Cardiol. 1991 Feb 1;67(4):231-5. doi: 10.1016/0002-9149(91)90551-u.
The timing of Q-wave evolution and its prognostic significance was studied in 201 patients who received thrombolytic therapy for a first acute myocardial infarction (AMI). One hundred forty-one patients (70%) had evidence of a Q-wave AMI within 3 hours of the initiation of thrombolytic therapy, 31 (16%) developed Q waves after 3 hours but before hospital discharge, and 29 (14%) were discharged with a non-Q-wave AMI. Laboratory indicators of myocardial damage and in-hospital morbidity and mortality were greater among patients with Q-wave AMIs than with non-Q-wave AMIs. When these indexes were examined with respect to the timing of Q-wave evolution, the prognosis of patients with delayed Q-wave development was similar to that of patients with non-Q-wave AMIs. Thus, compared to patients with early (less than or equal to 3 hours) Q-wave evolution, patients with delayed Q-wave evolution or with a non-Q-wave AMI had a smaller creatine kinase peak (mean 661 to 1,081 vs 1,251 to 1,541 IU; p = 0.005), better preservation of left ventricular function as measured by radionuclide ventriculography before discharge (mean +/- standard deviation 54 +/- 11% vs 47 +/- 13%; p less than 0.01), and a lower incidence of congestive heart failure at discharge (3 vs 15%; p = 0.02). In-hospital mortality was lower among patients with delayed Q-wave evolution or with a non-Q-wave AMI (5 of 141 vs 0 of 60; difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)
对201例首次急性心肌梗死（AMI）接受溶栓治疗的患者，研究了Q波演变的时间及其预后意义。141例患者（70%）在溶栓治疗开始后3小时内出现Q波型AMI的证据，31例（16%）在3小时后但出院前出现Q波，29例（14%）出院时为非Q波型AMI。Q波型AMI患者的心肌损伤实验室指标以及住院发病率和死亡率均高于非Q波型AMI患者。当就Q波演变时间检查这些指标时，Q波出现延迟的患者的预后与非Q波型AMI患者相似。因此，与早期（小于或等于3小时）Q波演变的患者相比，Q波演变延迟或非Q波型AMI患者的肌酸激酶峰值较小（平均661至1081对1251至1541 IU；p = 0.005），出院前放射性核素心室造影测量的左心室功能保存更好（平均±标准差54±11%对47±13%；p<0.01），出院时充血性心力衰竭的发生率较低（3%对15%；p = 0.02）。Q波演变延迟或非Q波型AMI患者的住院死亡率较低（141例中的5例对60例中的0例；差异不显著）。（摘要截短于250字）
