COMPARISON OF CORONARY ANGIOGRAPHIC FINDINGS DURING THE FIRST 6 HOURSOF NON-Q-WAVE AND Q-WAVE MYOCARDIAL-INFARCTION

The angiographic features of non-Q-wave acute myocardial infarction (A MI) soon after symptom onset have not been previously reported. Accord ingly, this study reviewed the coronary angiographic findings of 86 pa tients with AMI studied within 6 hours of symptom onset: 58 had Q-wave and 28 had non-Q-wave AMI. Patients with Q-wave and non-Q-wave AMI we re comparable in terms of clinical characteristics, frequency of 1-ves sel disease, and infarct-related artery location. Thrombus was observe d in 49 patients (84%) with Q-wave AMI versus 12 (43%) with non-Q-wave AMI (p = 0.0002). Whereas complete occlusion of the infarct-related a rtery was present in 53 patients (91%) with Q-wave AMI, total coronary occlusion was present in only 11 (39%) with non-Q-wave AMI (p = 0.000 1). Collaterals to occluded infarct arteries were seen in 10 patients (19%) with Q-wave AMI versus 5 (45%) with non-Q-wave AMI (p = 0.06). R esidual perfusion of the infarct artery by either anterograde or colla teral now was typical of patients with non-a-wave AMI (22 of 28, 79%) but was uncommon in those with Q-wave AMI (15 of 58, 26%) (p = 0.0001) . Thus, coronary angiography performed within 6 hours of symptom onset demonstrates important differences between Q-wave and non-Q-wave AMI. Non-Q-wave AMI is characterized by partial perfusion of the infarct-r elated artery by either anterograde or collateral now, acid a lower in cidence of thrombus than Q-wave AMI. These anatomic findings explain t he clinical course of patients with non-Q-wave AMI and may be helpful in developing therapeutic strategies.