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Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.

Publication ,  Journal Article
Siha, H; Das, D; Fu, Y; Zheng, Y; Westerhout, CM; Storey, RF; James, S; Wallentin, L; Armstrong, PW
Published in: CMAJ
July 10, 2012

BACKGROUND: Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial METHODS: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality. RESULTS: Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02). INTERPRETATION: The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. Clinical Trials.gov registration no. NCT00391872.

Duke Scholars

Published In

CMAJ

DOI

EISSN

1488-2329

Publication Date

July 10, 2012

Volume

184

Issue

10

Start / End Page

1135 / 1142

Location

Canada

Related Subject Headings

  • Troponin T
  • Troponin I
  • Treatment Outcome
  • Time Factors
  • Ticlopidine
  • Ticagrelor
  • Survival Analysis
  • Purinergic P2Y Receptor Antagonists
  • Prospective Studies
  • Prognosis
 

Citation

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Siha, H., Das, D., Fu, Y., Zheng, Y., Westerhout, C. M., Storey, R. F., … Armstrong, P. W. (2012). Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial. CMAJ, 184(10), 1135–1142. https://doi.org/10.1503/cmaj.111683
Siha, Hany, Debraj Das, Yuling Fu, Yinggan Zheng, Cynthia M. Westerhout, Robert F. Storey, Stefan James, Lars Wallentin, and Paul W. Armstrong. “Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.CMAJ 184, no. 10 (July 10, 2012): 1135–42. https://doi.org/10.1503/cmaj.111683.
Siha H, Das D, Fu Y, Zheng Y, Westerhout CM, Storey RF, et al. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial. CMAJ. 2012 Jul 10;184(10):1135–42.
Siha, Hany, et al. “Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.CMAJ, vol. 184, no. 10, July 2012, pp. 1135–42. Pubmed, doi:10.1503/cmaj.111683.
Siha H, Das D, Fu Y, Zheng Y, Westerhout CM, Storey RF, James S, Wallentin L, Armstrong PW. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial. CMAJ. 2012 Jul 10;184(10):1135–1142.

Published In

CMAJ

DOI

EISSN

1488-2329

Publication Date

July 10, 2012

Volume

184

Issue

10

Start / End Page

1135 / 1142

Location

Canada

Related Subject Headings

  • Troponin T
  • Troponin I
  • Treatment Outcome
  • Time Factors
  • Ticlopidine
  • Ticagrelor
  • Survival Analysis
  • Purinergic P2Y Receptor Antagonists
  • Prospective Studies
  • Prognosis