Aguirre F V, Younis L T, Chaitman B R, Ross A M, McMahon R P, Kern M J, Berger P B, Sopko G, Rogers W J, Shaw L
St Louis University Health Sciences Center, Division of Cardiology, MO 63110, USA.
Circulation. 1995 May 15;91(10):2541-8. doi: 10.1161/01.cir.91.10.2541.
There are few data comparing clinical outcome and potential indications for routine post-myocardial infarction cardiac catheterization and revascularization of patients who sustain a non-Q-wave versus Q-wave infarct after thrombolytic therapy.
A secondary analysis of 2634 patients enrolled in the TIMI II trial with a first myocardial infarction was performed to determine 6-week and 1-year cardiac event rates and identify clinical and angiographic differences between the 1867 patients (70.9%) who evolved a Q-wave infarct and the 767 patients (29.1%) who sustained a non-Q-wave infarct after treatment with intravenous thrombolytic therapy. Male sex (85.3% versus 75.6%; P < .001) and anterior wall infarcts (53.8% versus 43.7%; P < .001) were more frequent in the Q-wave versus the non-Q-wave group. During recombinant tissue-type plasminogen activator (rTPA) infusion, a greater percentage of non-Q-wave patients (37.3% versus 23.5%; P = .001) had normalization of initial ST-segment elevation. Infarct-related artery patency (TIMI flow grade 2 or 3) (P = .02), complete infarct-related artery reperfusion (TIMI 3 flow grade) (P < .001), and the percentage of patients with a predischarge resting left ventricular ejection fraction > 55% (P < .001) were greater in the non-Q-wave group. New congestive heart failure during hospitalization developed more frequently in Q-wave patients (18.9% versus 11.6%; P < .001). After 42 days, the occurrences of reinfarction (P = .76), death (P = .76), and combined death or reinfarction (P = .43) were similar in patients assigned to the invasive or conservative postlytic management strategy, regardless of infarct type. One-year mortality was 3.4% versus 4.4% for non-Q-wave versus Q-wave infarct type, respectively (P = .25).
Angiographic and clinical differences were observed between patients who present with initial ST-segment elevation and evolve early non-Q-wave versus Q-wave myocardial infarcts after treatment with rTPA, heparin, and aspirin. Early mortality and adverse clinical cardiac events in these patients are not significantly different after a conservative compared with an invasive treatment strategy, regardless of whether the infarct type is non-Q wave or Q wave.
关于接受溶栓治疗后发生非Q波梗死与Q波梗死的患者，常规心肌梗死后心脏导管插入术及血运重建的临床结局和潜在适应证的比较数据较少。
对参加TIMI II试验的2634例首次发生心肌梗死的患者进行二次分析，以确定6周和1年时的心脏事件发生率，并识别1867例（70.9%）发生Q波梗死的患者与767例（29.1%）接受静脉溶栓治疗后发生非Q波梗死的患者之间的临床和血管造影差异。Q波组男性（85.3%对75.6%；P<.001）和前壁梗死（53.8%对43.7%；P<.001）比非Q波组更常见。在重组组织型纤溶酶原激活剂（rTPA）输注期间，更大比例的非Q波患者（37.3%对23.5%；P=.001）初始ST段抬高恢复正常。非Q波组梗死相关动脉通畅（TIMI血流分级2或3）（P=.02）、梗死相关动脉完全再灌注（TIMI 3血流分级）（P<.001）以及出院前静息左心室射血分数>55%的患者比例（P<.001）更高。住院期间新发充血性心力衰竭在Q波患者中更常见（18.9%对11.6%；P<.001）。42天后，无论梗死类型如何，接受侵入性或保守性溶栓后管理策略的患者再梗死（P=.76）、死亡（P=.76）以及死亡或再梗死合并发生率（P=.43）相似。非Q波梗死类型与Q波梗死类型的1年死亡率分别为3.4%和4.4%（P=.25）。
在用rTPA、肝素和阿司匹林治疗后，初始ST段抬高并早期发生非Q波与Q波心肌梗死的患者之间存在血管造影和临床差异。无论梗死类型是非Q波还是Q波，与侵入性治疗策略相比，保守治疗策略后这些患者的早期死亡率和不良临床心脏事件无显著差异。
