Goodman S G, Langer A, Ross A M, Wildermann N M, Barbagelata A, Sgarbossa E B, Wagner G S, Granger C B, Califf R M, Topol E J, Simoons M L, Armstrong P W
The Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Ontario, Canada.
Circulation. 1998 Feb 10;97(5):444-50. doi: 10.1161/01.cir.97.5.444.
Although the stratification of patients with myocardial infarction into ECG subsets based on the presence or absence of new Q waves has important clinical and prognostic utility, systematic evaluation of the impact of thrombolytic therapy on the subsequent development and prognosis of non-Q-wave infarction has been limited to date.
We examined 12-lead ECG, coronary anatomy, left ventricular function, and mortality among 2046 patients with ST-segment elevation infarction from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries angiographic subset to gain further insight into the pathophysiology and prognosis of Q- versus non-Q-wave infarction in the thrombolytic era. Non-Q-wave infarction developed in 409 patients (20%) after thrombolytic therapy. Compared with Q-wave patients, non-Q-wave patients were more likely to present with lesser ST-segment elevation in a nonanterior location. The infarct-related artery in non-Q-wave patients was more likely to be nonanterior (67% versus 58%, P=.012) and distally located (33% versus 39%, P=.021). Early (90-minute, 77% versus 65%, P=.001) and complete (54% versus 44%, P<.001) infarct-related artery patency was greater among the non-Q-wave group. Non-Q-wave patients had better global (ejection fraction, 66% versus 57%; P<.0001) and regional left ventricular function (10 versus 24 abnormal chords, P=.0001). In-hospital, 30-day, 1-year, and 2-year (6.3% versus 10.1%, P=.02) mortality rates were lower among non-Q-wave patients.
The excellent prognosis among the subgroup of patients who develop non-Q-wave infarction after thrombolysis is related to early, complete, and sustained infarct-related artery patency with resultant limitation of left ventricular infarction and dysfunction.
尽管根据新Q波的有无将心肌梗死患者分层为心电图亚组具有重要的临床和预后价值，但迄今为止，溶栓治疗对非Q波梗死后续发展和预后影响的系统评估仍然有限。
我们对全球应用链激酶和组织型纤溶酶原激活剂治疗冠状动脉闭塞（GUSTO）血管造影亚组中2046例ST段抬高型梗死患者的12导联心电图、冠状动脉解剖结构、左心室功能和死亡率进行了研究，以进一步了解溶栓时代Q波梗死与非Q波梗死的病理生理学和预后。409例患者（20%）在溶栓治疗后发生非Q波梗死。与Q波患者相比，非Q波患者更可能表现为非前壁部位ST段抬高程度较轻。非Q波患者的梗死相关动脉更可能是非前壁的（67%对58%，P = 0.012）且位于远端（33%对39%，P = 0.021）。非Q波组早期（90分钟时，77%对65%，P = 0.001）和完全（54%对44%，P < 0.001）梗死相关动脉通畅率更高。非Q波患者的整体（射血分数，66%对57%；P < 0.0001）和局部左心室功能更好（异常腱索分别为10根和24根，P = 0.0001）。非Q波患者的住院、30天、1年和2年死亡率（6.3%对10.1%，P = 0.02）更低。
溶栓后发生非Q波梗死的患者亚组预后良好与梗死相关动脉早期、完全和持续通畅有关，并由此限制了左心室梗死和功能障碍。
