Matetzky S, Barabash G I, Rabinowitz B, Rath S, Zahav Y H, Agranat O, Kaplinsky E, Hod H
Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.
J Am Coll Cardiol. 1995 Nov 15;26(6):1445-51. doi: 10.1016/0735-1097(95)00346-0.
We studied the clinical outcome of Q wave and non-Q wave infarction after thrombolytic therapy.
Controversy exists over the clinical significance of Q waves after thrombolysis.
We studied postthrombolytic angiographic results and short- and long-term clinical outcome in 150 patients with acute myocardial infarction classified as Q wave and non-Q wave on the 24-h and discharge electrocardiograms (ECGs). The results from the two groups were then compared.
Eighty percent of patients had a Q wave and 20% a non-Q wave infarction on the 24-h ECG. The latter patients had lower peak creatine kinase (CK) levels (p < 0.001), but the two groups did not differ significantly otherwise. In 18 patients with a Q wave infarction on the 24-h ECG, pathologic Q waves disappeared. However, in seven patients with a non-Q wave infarction on the 24-h ECG, pathologic Q waves appeared throughout the hospital period. Q wave regression was associated with lower peak CK levels (p < 0.001) and an improvement in left ventricular ejection fraction (p < 0.01). Thus, only 72% of patients had a Q wave and 28% a non-Q wave infarction on the discharge ECG. Patients with a non-Q wave infarction on the discharge ECG had higher patency of the infarct-related artery (p < 0.04), lower mean peak CK levels (p < 0.0001), a higher ejection fraction (p = 0.001) and a lower incidence of heart failure (p = 0.06) than patients with a Q wave infarction on the discharge ECG. Although the 2-year incidence of reinfarction and revascularization was higher in patients with a non-Q wave infarction on the discharge ECG (p < 0.05), 2-year mortality was lower (p = 0.08).
Although the early postthrombolytic distinction between Q wave and non-Q wave infarction conveys no significant information, during the hospital period, non-Q wave infarction is associated with a smaller infarct area, improved left ventricular function and lower mortality.
我们研究了溶栓治疗后Q波和非Q波梗死的临床结局。
溶栓后Q波的临床意义存在争议。
我们研究了150例急性心肌梗死患者溶栓后的血管造影结果以及短期和长期临床结局，这些患者在24小时及出院时心电图（ECG）上被分类为Q波和非Q波梗死。然后比较两组的结果。
在24小时心电图上，80%的患者为Q波梗死，20%为非Q波梗死。后一组患者的肌酸激酶（CK）峰值水平较低（p<0.001），但两组在其他方面无显著差异。在24小时心电图上有Q波梗死的18例患者中，病理性Q波消失。然而，在24小时心电图上有非Q波梗死的7例患者中，整个住院期间病理性Q波出现。Q波消退与较低的CK峰值水平（p<0.001）和左心室射血分数的改善（p<0.01）相关。因此，出院时心电图上只有72%的患者为Q波梗死，28%为非Q波梗死。出院时心电图上有非Q波梗死的患者与出院时心电图上有Q波梗死的患者相比，梗死相关动脉的通畅率更高（p<0.04），平均CK峰值水平更低（p<0.0001），射血分数更高（p=0.001），心力衰竭发生率更低（p=0.06）。尽管出院时心电图上有非Q波梗死的患者再梗死和血运重建的2年发生率更高（p<0.05），但2年死亡率更低（p=0.08）。
尽管溶栓后早期区分Q波和非Q波梗死并无显著信息，但在住院期间，非Q波梗死与梗死面积较小、左心室功能改善和死亡率较低相关。
