Prognostic importance of new small Q waves following Non–ST-Elevation acute coronary syndromes - 28/08/11
, Robert A Harrington, MD a, Manju Bhapkar, MS a, Kenneth W Mahaffey, MD a, A.Michael Lincoff, MD b, E.Magnus Ohman, MD c, Peter Klootwijk, MD d, Olle Pahlm, MD e, Bo Henden, MD e, Jaap W Deckers, MD d, Maarten L Simoons, MD d, Robert M Califf, MD a, Galen S Wagner, MD aAbstract |
Purpose |
To investigate the prognostic importance of new small Q waves following an acute coronary syndrome.
Methods |
We assessed 6-month mortality in 10,501 patients with non–ST-elevation acute coronary syndromes who had survived 30 days and had both admission and 30-day electrocardiograms. Patients were stratified by whether they had no new Q waves (n = 9447), new 30- to 40-ms Q waves (n = 733), or new ≥40-ms Q waves (n = 321).
Results |
Mortality was higher in patients with 30- to 40-ms Q waves than in those with no new Q waves (3.4% [25/733] vs. 2.4% [227/9447], P = 0.005), and even higher in those with ≥40-ms Q waves (5.3% [17/321], P = 0.002). After adjustment for baseline risk predictors, mortality remained higher in patients with new 30- to 40-ms Q waves (odds ratio [OR] = 1.30; 95% confidence interval [CI]: 0.85 to 1.98; P = 0.23) and those with new ≥40-ms Q waves (OR = 1.87; 95% CI: 1.13 to 3.09; P = 0.01).
Conclusion |
Patients with new small Q waves following a non–ST-elevation acute coronary syndrome are at increased risk of adverse outcomes. These small Q waves should be considered diagnostic of myocardial infarction. Further research should investigate whether even smaller QRS changes are prognostically important.
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 | The Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) study was funded by grants from COR Therapeutics, Inc., South San Francisco, California, and Schering-Plough Research Institute, Kenilworth, New Jersey. |
Vol 115 - N° 8
P. 613-619 - décembre 2003 Retour au numéro
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