THE PREDICTIVE VALUE OF THE ELECTROCARDIOGRAPHIC PATTERN OF ACUTE Q-WAVE MYOCARDIAL-INFARCTION FOR RECURRENT ISCHEMIA

A total of 140 consecutive patients with acute Q-wave myocardial infar ction was evaluated to assess the relationship between different elect rocardiographic patterns of evolution and the incidence of recurrent i schemia within 10 days of infarction. Patients were allocated to three groups according to the electrocardiogram at 12 h after admission: Gr oup A: ST elevation of < 2 mm and negative T waves (75 patients); Grou p B: ST elevation of > 2 mm and negative T waves (35 patients); Group C: ST elevation of > 2 mm and positive T waves (30 patients). Patients in Group C had more anterior wall infarctions (82%) than Group A (40% ) or Group B (58%) (p = 0.0001). Peak creatine kinase levels were lowe r in Group A (782 +/- 115 IU) than in Groups B (1415 +/- 257 IU) and C (1501 +/- 287 IU) (p < 0.0001). The occurrence of postinfarction recu rrent ischemia was more frequent in Group A (79.2%) than in Groups B ( 33.3%) and C (14.8%) (p < 0.0001). Patients in Group A had relatively smaller infarctions and a higher incidence of recurrent ischemia, wher eas patients in Group C had larger infarctions and a lower incidence o f recurrent ischemia. The electrocardiographic pattern 12 h after admi ssion for acute myocardial infarction is helpful in identifying a subg roup at high risk of recurrent ischemia.