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Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI
- Source :
- Journal of electrocardiology, Journal of electrocardiology, 2019, ⟨10.1016/j.jelectrocard.2019.09.022⟩
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- Background: Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after re-perfusion with clinical outcomes after anterior STEMI.Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had re-gression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/ or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year.Results: There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave re-gression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 +/- 2784 IU/l vs. 3814 +/- 2595 IU/l vs. 1733 +/- 1583 IU/l respectively, p b 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09).Conclusion: Ina population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.(c) 2019 Elsevier Inc. All rights reserved.
- Subjects :
- medicine.medical_specialty
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Population
Myocardial Infarction
Left ventricle remodeling
Stunned myocardium
030204 cardiovascular system & hematology
Lower risk
Infarct size
QT interval
Ventricular Function, Left
Electrocardiography
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
education
Creatine Kinase
Heart Failure
education.field_of_study
Ejection fraction
biology
Anterior ST-elevation myocardial infarction
business.industry
Percutaneous coronary intervention
Stroke Volume
Q wave regression
medicine.disease
3. Good health
Heart failure
Conventional PCI
biology.protein
Cardiology
ST Elevation Myocardial Infarction
Creatine kinase
Human medicine
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00220736
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Journal of Electrocardiology
- Accession number :
- edsair.doi.dedup.....4520cc6223b3db080fde2c84fa08687f