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Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.

Publication ,  Journal Article
Armstrong, PW; Fu, Y; Westerhout, CM; Hudson, MP; Mahaffey, KW; White, HD; Todaro, TG; Adams, PX; Aylward, PEG; Granger, CB
Published in: J Am Coll Cardiol
April 28, 2009

OBJECTIVES: We assessed the incremental value of baseline Q waves over time from symptom onset as a marker of clinical outcome in ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Time from symptom onset is a central focus in STEMI patients. The presence of Q waves on the baseline electrocardiogram (ECG) has been suggested to be of incremental value to time from symptom onset in evaluating clinical outcomes. METHODS: We evaluated baseline Q waves and ST-segment resolution 30 min after primary percutaneous intervention (PCI) ECGs in 4,530 STEMI patients without prior infarction. Additionally, peak biomarkers; 90-day mortality; and the composite of death, congestive heart failure (CHF), or cardiogenic shock were assessed. RESULTS: Fifty-six percent of patients had baseline Q waves: they were older, more frequently male and diabetic, and had a more advanced Killip class. Patients with baseline Q waves had greater mortality and a higher composite rate of death, CHF, and shock versus patients without baseline Q waves at 90 days (5.3% vs. 2.1% and 12.1% vs. 4.8%, respectively, both p < 0.001). Complete ST-segment resolution was highest, whereas 90-day mortality and the composite outcome were lowest among those randomized < or =3 h without baseline Q waves. After multivariable adjustment, baseline Q-wave but not time from symptom onset was significantly associated with a 78% relative increase in the hazard of 90-day mortality and a 90% relative increase in the hazard of death, shock, and CHF. CONCLUSIONS: Baseline Q waves in STEMI patients treated with primary PCI provide an independent prognostic marker of clinical outcome. These data might be useful in designing future clinical trials as well as in evaluating patients for triage and potential transfer for planned primary PCI. (Pexelizumab in Conjunction With Angioplasty in Acute Myocardial Infarction [APEX-AMI]; NCT00091637).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 28, 2009

Volume

53

Issue

17

Start / End Page

1503 / 1509

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Single-Chain Antibodies
  • Prognosis
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Armstrong, P. W., Fu, Y., Westerhout, C. M., Hudson, M. P., Mahaffey, K. W., White, H. D., … Granger, C. B. (2009). Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. J Am Coll Cardiol, 53(17), 1503–1509. https://doi.org/10.1016/j.jacc.2009.01.046
Armstrong, Paul W., Yuling Fu, Cynthia M. Westerhout, Michael P. Hudson, Kenneth W. Mahaffey, Harvey D. White, Thomas G. Todaro, Peter X. Adams, Philip E. G. Aylward, and Christopher B. Granger. “Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.J Am Coll Cardiol 53, no. 17 (April 28, 2009): 1503–9. https://doi.org/10.1016/j.jacc.2009.01.046.
Armstrong PW, Fu Y, Westerhout CM, Hudson MP, Mahaffey KW, White HD, et al. Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2009 Apr 28;53(17):1503–9.
Armstrong, Paul W., et al. “Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.J Am Coll Cardiol, vol. 53, no. 17, Apr. 2009, pp. 1503–09. Pubmed, doi:10.1016/j.jacc.2009.01.046.
Armstrong PW, Fu Y, Westerhout CM, Hudson MP, Mahaffey KW, White HD, Todaro TG, Adams PX, Aylward PEG, Granger CB. Baseline Q-wave surpasses time from symptom onset as a prognostic marker in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2009 Apr 28;53(17):1503–1509.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 28, 2009

Volume

53

Issue

17

Start / End Page

1503 / 1509

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Single-Chain Antibodies
  • Prognosis
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans