ABNORMAL Q-WAVES ON THE ADMISSION ELECTROCARDIOGRAM OF PATIENTS WITH FIRST ACUTE MYOCARDIAL-INFARCTION - PROGNOSTIC IMPLICATIONS

Background: Q waves developed in the subacute and persisting into the chronic phase of myocardial infarction (MI) usually signify myocardial necrosis. However, the mechanism and significance of Q waves that app ear very early in the course of acute MI (< 6 h from onset of symptoms ), especially if accompanied by ST elevation, are probably different. Hypothesis: This study assesses the prognostic implications of abnorma l Q waves on admission in 2,370 patients with first acute MI treated w ith thrombolytic therapy < 6 h of onset of symptoms. Results: Patients with abnormal Q waves in greater than or equal to 2 leads with ST-seg ment elevation (n = 923) were older than patients without early Q wave s (n = 1,447) (60.6 +/- 11.9 vs. 58.8 +/- 11.9 years, respectively; p = 0.0003), and had a greater incidence of hypertension (34.3 vs. 30.5% ; p = 0.05) and anterior MI (60.6 vs. 41.1%; p < 0.0001). Time from on set of symptoms to therapy was longer in patients with Q waves upon ad mission (208 +/- 196 vs. 183 +/- 230 min; p = 0.01). Peak serum creati ne kinase (2235 +/- 1544 vs. 1622 +/- 1536 IU; p < 0.0001), prevalence of heart failure during hospitalization (13.8 vs. 7.0%, p < 0.0002), hospital mortality (8.0 vs. 4.6%; p = 0.02), and cardiac mortality (6. 6 vs. 4.5%, p = 0.11) were higher in patients with anterior MI and wit h abnormal Q waves than in those without abnormal Q waves upon admissi on. There was no difference in peak creatine kinase, prevalence of hea rt failure, in-hospital mortality, and cardiac mortality between patie nts with and without abnormal Q waves in inferior MI. Multivariate reg ression analysis confirmed that mortality is independently associated with presence of Q waves on admission (odds ratio 1.61; 95% CI 1.04-2. 49; p = 0.04 for all patients; odds ratio 1.65; 95% CI 0.97-2.83; p = 0.09 for anterior wall MI. Conclusion: Abnormal Q waves on the admissi on electrocardiogram (ECG) are associated with higher peak creatine ki nase, higher prevalence of heart failure, and increased mortality in p atients with anterior MI. Abnormal Q waves on the admission ECG of pat ients with inferior MI are not associated with adverse prognosis.