Use of resources, quality of life, and clinical outcomes in patients with and without new Q waves after thrombolytic therapy for acute myocardial infarction (from the GUSTO-I trial)

Previous reports indicate that patients who do not develop Q waves after th rombolytic therapy are a different population with a better long-term survi val than those who do develop Q waves. However, the use of resources, quali ty of life, and health status of this population have not been fully evalua ted. Using data from the Economics and Quality of Life subset of the Global Utilization of Streptokinase and tPA for Occluded Arteries study, we exami ned 30-day and 1-year mortality, use of resources, and quality-of-life meas ures among 1,830 of 3,000 patients with acute myocardial infarction and ST- segment elevation treated with thrombolytic therapy. At hospital discharge, 555 patients (30.2%) had not developed Q waves. These patients had lower m ortality than patients with Q waves at 30 days (1.6% vs 4.5%, p <0.01) and at 1 year (4.7% vs 6.8%, p <0.04). Recurrent chest pain and dyspnea were si milar at 30 days and 1 year. Patients without Q waves had significantly mor e angiography and trends coward higher readmission, revascularization, and use of calcium antagonists at 30 days. Angiography, revascularization, read mission, and quality of life were equivalent from 30 days to 1 year, with n o sign of late instability. Logistic regression analysis showed an associat ion between in-hospital revascularization and better survival and quality o f life at 1 year. Conversely, there was no association between in-hospital use of calcium antagonists and outcome to explain the lower mortality in no n-Q-wave patients. The absence of Q waves after thrombolytic therapy is a m arker of success, implying better prognosis and equivalent quality of life, use of resources, and health status than for patients with Q-wave acute my ocardial infarction and no sign of long-term unstable clinical course. (C) 2000 by Excerpta Medica, Inc.