Long-Term Prognostic Value of Less-Stringent Electrocardiographic Q Waves and Fourth Universal Definition of Myocardial Infarction Q Waves - 22/05/20

Doi : 10.1016/j.amjmed.2019.08.056

Christoffer Polcwiartek, MD ^a,^b,^c,^d,^⁎ , Kristian Kragholm, MD, PhD ^a,^b,^e, Daniel J. Friedman, MD ^c, Brett D. Atwater, MD ^c, Claus Graff, MSc, PhD ^f, Jonas B. Nielsen, MD, PhD ^g,^h, Anders G. Holst, MD, PhD ^g, Johannes J. Struijk, MSc, PhD ^f, Adrian Pietersen, MD ⁱ, Jesper H. Svendsen, MD, DMSc ^g,^j,^k, Lars Køber, MD, DMSc ^j,^k, Peter Søgaard, MD, DMSc ^a,^d, Svend E. Jensen, MD, PhD ^a,^d, Christian Torp-Pedersen, MD, DMSc ^a,^b,^d,^f, Steen M. Hansen, MD, PhD ^b
^a Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
^b Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
^c Division of Cardiology, Duke University Medical Center, Durham, NC, USA
^d Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
^e Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
^f Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
^g Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
^h Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
ⁱ Copenhagen General Practitioners’ Laboratory, Copenhagen, Denmark
^j Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
^k Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

^⁎Requests for reprints should be addressed to Dr. Christoffer Polcwiartek, Department of Cardiology, Aalborg University Hospital, Hobrovej 18–22, DK-9000 Aalborg, DenmarkDepartment of CardiologyAalborg University HospitalHobrovej 18–22AalborgDK-9000Denmark

Abstract

Background

The Fourth Universal Definition of Myocardial Infarction defines electrocardiographic Q waves as duration ≥30 ms and amplitude ≥1 mm or QS complex in 2 contiguous leads. However, current taskforce criteria may be overly restrictive. Therefore, we investigated the association of isolated, lenient, or strict Q waves with long-term outcome.

Methods

From 2001 to 2015, we included Danish primary care patients with digital electrocardiograms (ECGs) that were evaluated for Q waves. If none occurred, patients had no Q waves. If no other contiguous Q wave occurred, patients had isolated Q waves. If another contiguous Q wave occurred meeting only 1 criterion (≥30 ms and <1 mm or <30 ms and ≥1 mm), patients had lenient Q waves. If another contiguous Q wave occurred, patients had strict Q waves.

Results

Of 365,206 patients, 87,957 had isolated, lenient, or strict Q waves (24%; median age, 61 years; male, 48%), and 277,249 had no Q waves (76%; median age, 53 years; male, 42%). Mortality risk was increased with isolated (all-cause adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.29-1.37; cardiovascular-cause aHR, 1.78; 95% CI, 1.70-1.87), lenient (all-cause aHR, 1.41; 95% CI, 1.33-1.50; cardiovascular-cause aHR, 1.78; 95% CI, 1.63-1.94), or strict (all-cause aHR, 1.64; 95% CI, 1.57-1.72; cardiovascular-cause aHR, 2.70; 95% CI, 2.52-2.89) Q waves compared with no Q waves. Highest mortality risk was associated with lenient or strict Q waves in anteroseptal leads.

Conclusions

This large contemporary analysis suggests that less-stringent Q-wave criteria carry prognostic value in predicting adverse outcome among primary care patients.

Le texte complet de cet article est disponible en PDF.

Keywords : Electrocardiogram, Epidemiology, Fourth Universal Definition of Myocardial Infarction, Myocardial infarction, Primary care, Q wave

Plan

Introduction

Methods

Study Design and Population

Q-Wave Subtypes

Comorbidities, Procedures, and Cardiovascular Drugs

Patient Characteristics

Mortality Risk by Q-Wave Subtypes

	Funding: None.
	Conflict of Interest: CG, JBN, JJS, and AP report none. CP received speaking fees from Lundbeck Pharma A/S and research grants from the Danish Heart Foundation and Eva and Henry Frænkel Memorial Foundation. KK received speaking fees from Novartis and research grants from the Laerdal Foundation. DJF received salary support from the National Institutes of Health; research grants from Abbott, Biosense Webster, Boston Scientific, and the National Cardiovascular Data Registry; and educational grants from Abbott, Biotronik, Boston Scientific, and Medtronic. BDA reported receiving speaking fees from Medtronic; research grants from Abbott and Boston Scientific; and acted as adviser to Abbott, Biotronik, and Medtronic. AGH reported being an employee of Novo Nordisk. JHS received speaking fees from Medtronic; research grants from Gilead and Medtronic; and acted as adviser to Medtronic. LK received speaking fees from Novartis. PS received research grants from Biotronik and GE Healthcare and acted as adviser to Biotronik. SEJ received research grants from the Obel Family Foundation. CTP received speaking fees from Bayer and research grants from Bayer and Biotronik. SMH received speaking fees from AstraZeneca and research grants from the Danish Heart Foundation, TrygFonden, and Laerdal Foundation.
	Authorship: All authors had access to the data and a role in writing this manuscript.