Wang J H, Qian Y J, Tao H L
Zhonghua Nei Ke Za Zhi. 1989 Dec;28(12):706-7, 766.
A long-term follow-up study of 21 cases with 24 attacks of acute non-Q-wave myocardial infarction (MI) was reported. These cases had been followed up for an average of 21.1 months, the longest being 7 years and the shortest only 8 days in a fatal case. It was shown that in the acute stage the mortality rate of non-Q-wave MI (14.3%) was slightly lower than that of Q-wave MI (18.9%). However, at the end of 2 years the cumulative mortality rate of non-Q-wave MI (33.3%) was higher than that of Q-wave MI (26.2%) and the rate of reinfarction during the follow-up in the former (38%) was much higher than that in the latter (17.3%). Among the 21 patients, 11 died of cardiac or noncardiac causes during the follow-up. Autopsy was obtained in 9 of the 11 cases. Clinicopathological correlation showed that the present diagnostic criteria for non-Q-wave MI with positive findings in clinical manifestation, electrocardiography and serum enzyme is practical and reliable. 3 of the 9 autopsied cases with negative serum enzyme were also proved to have subendocardial infarction pathologically, but in 2 of them the thickness of the lesion was less than one third of that of ventricular wall. It is, thus, concluded that although non-Q-wave MI has better prognosis in the acute stage, yet its outlook in the long run is by no means good. Moreover, negative serum enzyme does not preclude the possibility of non-Q-wave MI.
报道了一项对21例发生24次急性非Q波心肌梗死（MI）发作的长期随访研究。这些病例平均随访了21.1个月，最长达7年，最短的仅8天（为1例死亡病例）。结果显示，在急性期，非Q波MI的死亡率（14.3%）略低于Q波MI（18.9%）。然而，在2年结束时，非Q波MI的累积死亡率（33.3%）高于Q波MI（26.2%），且前者随访期间的再梗死率（38%）远高于后者（17.3%）。在这21例患者中，11例在随访期间死于心脏或非心脏原因。11例中有9例进行了尸检。临床病理相关性研究表明，目前非Q波MI的临床表现、心电图及血清酶学阳性的诊断标准实用且可靠。9例尸检病例中，3例血清酶学阴性者经病理检查也证实有心内膜下梗死，但其中2例病变厚度小于心室壁厚度的三分之一。因此得出结论，尽管非Q波MI在急性期预后较好，但从长远来看其前景并不乐观。此外，血清酶学阴性并不能排除非Q波MI的可能性。
