Prognostic implications of quantitative evaluation of baseline Q-wave width in ST-segment elevation myocardial infarction.

Published

Journal Article

OBJECTIVES: To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Baseline Q-waves are useful in predicting clinical outcomes after MI. METHODS: 3589 STEMI patients were assessed from a multi-centre study. RESULTS: 1156 patients of the overall cohort had pathologic Q-waves. The 90-day mortality and the composite of mortality, congestive heart failure (CHF), or cardiogenic shock (p<0.001 for both outcomes) rose as Q-wave width increased. After adapting a threshold ≥40ms for inferior and ≥20ms for lateral/apical MI in all patients (n=3065) with any measureable Q-wave we found hazard ratios (HR) for mortality (HR: 2.44, 95% confidence interval (CI) (1.54-3.85), p<0.001) and the composite (HR: 2.32, 95% CI (1.70-3.16), p<0.001). This improved reclassification of patients experiencing the composite endpoint versus the conventional definition (net reclassification index (NRI): 0.23, 95% CI (0.09-0.36), p<0.001) and universal MI definition (NRI: 0.15, 95% CI (0.02-0.29), p=0.027). CONCLUSIONS: The width of the baseline Q-wave in STEMI adds prognostic value in predicting 90-day clinical outcomes. A threshold of ≥40ms in inferior and ≥20ms for lateral/apical MI enhances prognostic insight beyond current criteria.

Full Text

Duke Authors

Cited Authors

  • Bao, MH; Zheng, Y; Westerhout, CM; Fu, Y; Wagner, GS; Chaitman, B; Granger, CB; Armstrong, PW

Published Date

  • July 2014

Published In

Volume / Issue

  • 47 / 4

Start / End Page

  • 465 - 471

PubMed ID

  • 24853083

Pubmed Central ID

  • 24853083

Electronic International Standard Serial Number (EISSN)

  • 1532-8430

International Standard Serial Number (ISSN)

  • 0022-0736

Digital Object Identifier (DOI)

  • 10.1016/j.jelectrocard.2014.04.013

Language

  • eng