Houdmont Marie, Lim Eng How, Djohan Hartanto Andie, Lau Vianne, Chan Siew Pang, Win Saw Kalyar, Tung Benjamin, Ng Zhe Yan, Chan Mark, Lee Ronald, Low Adrian F, Tan Huay Cheem, Yeo Tiong-Cheng, Loh Poay Huan, Chan Koo Hui
Department of Cardiology, National University Heart Centre.
Yong Loo Lin School of Medicine, National University of Singapore.
Coron Artery Dis. 2025 Aug 1;36(5):378-383. doi: 10.1097/MCA.0000000000001475. Epub 2024 Dec 18.
Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population.
Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019. The presenting ECG was reviewed for pathological Q waves and patients were divided into groups with and without Q waves. The confirmatory multivariate analyses concerning the presence of Q wave, occurrence of heart failure, time to heart failure at 1 year, and the mortality status were performed with generalized structural equation model.
A total of 1385 patients were included. Patients with pathological Q waves were more likely to suffer from anterior myocardial infarction (55.6 vs. 43.6%) and classified as Killip class >2 (13.5 vs. 8.0%). Among them, fewer reported ST segment resolution >50% (66.5 vs. 79.7%). They reported significantly lower LVEF (45.5 vs. 51.1%), longer symptom onset to ECG (168 vs. 111 min), and longer symptom-onset-to-balloon time (228 vs. 176 min). In addition, patients with Q waves were likely to stay longer in hospital (6.4 vs. 6.1 days) and faced a higher risk of heart failure (5.2 vs. 2.5%) in a year.
We highlight the important morbidity associated with Q waves at presentation and found not only that heart failure occurrence was higher in the Q wave group, but there was also an acceleration of and shorter onset to heart failure.
ST段抬高型心肌梗死（STEMI）发病时出现病理性Q波与包括心力衰竭在内的较差临床结局相关。这项观察性研究强调了发病时病理性Q波在东南亚人群中的预后价值。
招募2015年至2019年期间出现STEMI并接受直接冠状动脉介入治疗的多民族亚洲患者。回顾发病时的心电图以检查病理性Q波，并将患者分为有Q波组和无Q波组。采用广义结构方程模型对Q波的存在、心力衰竭的发生、1年时发生心力衰竭的时间以及死亡状态进行验证性多变量分析。
共纳入1385例患者。有病理性Q波的患者更易发生前壁心肌梗死（55.6%对43.6%），且Killip分级>2级的比例更高（13.5%对8.0%）。其中，报告ST段回落>50%的患者较少（66.5%对79.7%）。他们的左心室射血分数显著更低（45.5%对51.1%），症状发作至心电图检查的时间更长（168分钟对111分钟），症状发作至球囊扩张的时间也更长（228分钟对176分钟）。此外，有Q波的患者住院时间可能更长（6.4天对6.1天），且一年内发生心力衰竭的风险更高（5.2%对2.5%）。
我们强调了发病时Q波相关的重要发病率，并发现不仅Q波组心力衰竭的发生率更高，而且心力衰竭的进展加速且发病时间缩短。
