New Q waves on the presenting electrocardiogram independently predict increased cardiac mortality following a first ST-elevation myocardial infarction

Aims The prognostic significance of pathological Q waves appearing in the a cute phase of myocardial infarction has not been determined. We investigate d whether new Q waves on the presenting electrocardiogram of patients with acute ST-segment elevation were independently associated with a worse outco me after a first myocardial infarction. Methods and Results The presence or absence of new Q waves on the presentin g electrocardiogram was assessed in 481 patients who presented within 4 h o f symptom onset and were randomized to receive either captopril or placebo within 2 h of streptokinase therapy for myocardial infarction. Ventriculogr aphy was performed at 22 +/- 6 days and mortality status was obtained at a median follow-up of 5.6 years. New Q waves were associated with a lower eje ction fraction (51 +/- 13% vs 61 +/- 12%, P<0.0001), a larger end-systolic volume index (37 ml vs 28 ml, P<0.001), and increased cardiac mortality at 30 days (7% vs 2%, P=0.01) and at follow-up (17% vs 7%, P=0.002). On multiv ariate analysis, age (P<0.01), new Q waves at presentation (P<0.01) and a h istory of angina (P=0.046) were independent predictors of cardiac mortality , whereas randomization to captopril and the time from symptom onset to str eptokinase administration were not. Conclusion New Q waves at presentation are independently associated with a worse outcome after a first myocardial infarction. The presence of new Q wa ves on the presenting electrocardiogram allows very early identification of patients at risk of increased cardiac mortality. (Eur Heart J 2000; 21: 64 7-653) (C) 2000 The European Society of Cardiology.