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Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators.

Publication ,  Journal Article
Barbagelata, A; Califf, RM; Sgarbossa, EB; Goodman, SG; Stebbins, AL; Granger, CB; Suarez, LD; Borruel, M; Gates, K; Starr, S; Wagner, GS
Published in: J Am Coll Cardiol
March 15, 1997

OBJECTIVES: We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis. BACKGROUND: Prethrombolytic era studies report conflicting short-versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity. METHODS: Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration > or = 30 ms in lead aVF; R wave > or = 40 ms in lead V1; any Q wave or R wave < or = 10 ms and < or = 0.1 mV in lead V2; or Q wave > or = 40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed. RESULTS: No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001). CONCLUSIONS: Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 1997

Volume

29

Issue

4

Start / End Page

770 / 777

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Analysis
  • Streptokinase
  • Plasminogen Activators
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
 

Citation

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Barbagelata, A., Califf, R. M., Sgarbossa, E. B., Goodman, S. G., Stebbins, A. L., Granger, C. B., … Wagner, G. S. (1997). Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators. J Am Coll Cardiol, 29(4), 770–777. https://doi.org/10.1016/s0735-1097(96)00587-6
Barbagelata, A., R. M. Califf, E. B. Sgarbossa, S. G. Goodman, A. L. Stebbins, C. B. Granger, L. D. Suarez, et al. “Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators.J Am Coll Cardiol 29, no. 4 (March 15, 1997): 770–77. https://doi.org/10.1016/s0735-1097(96)00587-6.
Barbagelata A, Califf RM, Sgarbossa EB, Goodman SG, Stebbins AL, Granger CB, Suarez LD, Borruel M, Gates K, Starr S, Wagner GS. Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators. J Am Coll Cardiol. 1997 Mar 15;29(4):770–777.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 1997

Volume

29

Issue

4

Start / End Page

770 / 777

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Analysis
  • Streptokinase
  • Plasminogen Activators
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans