Kosmidou Ioanna, Redfors Björn, Crowley Aaron, Gersh Bernard, Chen Shmuel, Dizon José M, Embacher Monica, Mehran Roxana, Ben-Yehuda Ori, Mintz Gary S, Stone Gregg W
Clinical Trials Center, Cardiovascular Research Foundation, New York City, New York.
Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York City.
Clin Cardiol. 2017 Nov;40(11):982-987. doi: 10.1002/clc.22751. Epub 2017 Jul 11.
Presence of Q waves on the presenting electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with worse prognosis; however, whether the prognostic value of Q waves is influenced by baseline characteristics and/or rapidity of revascularization based on the guideline-based metric of door-to-balloon time remains unknown.
We hypothesized that Q waves in the presenting ECG will be predictive of long term mortality regardless of time to reperfusion.
The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial enrolled 3602 patients with STEMI undergoing primary percutaneous coronary intervention. We stratified patients without prior history of myocardial infarction or coronary revascularization according to presence or absence of pathological Q waves on their presenting ECG. Associations between Q waves, death, and cardiovascular outcomes within 3 years were assessed using Cox proportional hazards regression.
Among 2723 patients with evaluable ECGs, 1084 (39.8%) had Q waves on their presenting ECG. Male sex and time from symptom onset to balloon inflation were independent predictors of presence of Q waves. Patients with Q waves had higher adjusted risks of all-cause death (adjusted hazard ratio: 1.45, 95% confidence interval: 1.02-2.05, P = 0.04) and cardiac death (adjusted hazard ratio: 1.72, 95% confidence interval: 1.08-2.72, P = 0.02). The association between Q waves and cardiac death was consistent regardless of sex, diabetes status, target vessel, or door-to-balloon time (P > 0.4 for all).
Presence of Q waves on the presenting ECG in patients undergoing primary percutaneous coronary intervention due to STEMI is an independent predictor of mortality and adds prognostic value, regardless of sex or rapidity of revascularization.
ST段抬高型心肌梗死（STEMI）患者就诊时心电图（ECG）上出现Q波与预后较差相关；然而，基于门球时间这一基于指南的指标，Q波的预后价值是否受基线特征和/或血运重建速度的影响尚不清楚。
我们假设就诊时心电图上的Q波将预测长期死亡率，而与再灌注时间无关。
急性心肌梗死血运重建和支架置入的协调结果（HORIZONS-AMI）试验纳入了3602例接受直接经皮冠状动脉介入治疗的STEMI患者。我们根据就诊时心电图上是否存在病理性Q波，对无心肌梗死或冠状动脉血运重建病史的患者进行分层。使用Cox比例风险回归评估Q波、死亡和3年内心血管结局之间的关联。
在2723例可评估心电图的患者中，1084例（39.8%）就诊时心电图上有Q波。男性以及从症状发作到球囊扩张的时间是Q波存在的独立预测因素。有Q波的患者全因死亡（调整后风险比：1.45，95%置信区间：1.02-2.05，P = 0.04）和心源性死亡（调整后风险比：1.72，95%置信区间：1.08-2.72，P = 0.02）的调整后风险更高。无论性别、糖尿病状态、靶血管或门球时间如何，Q波与心源性死亡之间的关联都是一致的（所有P>0.4）。
因STEMI接受直接经皮冠状动脉介入治疗的患者就诊时心电图上出现Q波是死亡率的独立预测因素，并增加了预后价值，无论性别或血运重建速度如何。
