Usefulness of echocardiography in the prognostic evaluation of non-Q-wave myocardial infarction

Patients with non-Q-wave myocardial infarction (MI) are a heterogeneous pop ulation with a wide range of coronary disease severity and extent of myocar dial necrosis, showing, therefore, different electrocardiographic findings and different outcomes. To evaluate the role of echocardiography in the man agement of non-Q-wave MI patients, 192 consecutive patients without previou s MI were studied (78 with ST segment elevation, 56 with ST depression and 58 without ST modifications). All patients underwent 2-dimensional echocard iography (16-segment model) within 24 hours of admission to the coronary ca re unit, Wall-motion abnormalities, wall-motion score index, election fract ion, and end-diastolic and end-systolic volumes were evaluated. In 35 patie nts, death, reinfarction, recurrent angina, or severe heart failure occurre d during the in-hospital phase, whereas the remaining 157 patients had a go od outcome, patients with a poor prognosis were older (68 +/- vs 59 +/- 5 y ears, p <0.01), had a worse left-ventricular function (wall-motion score in dex 1.4 +/- 0.4 vs 1.25 +/- 0.3, p <0.05; end-systolic volume 54 +/- 25 vs 38 +/- 12 mL/m(2), p <0.01;ejection fraction 50 +/- 10 vs 58 a 8%, p <0.01) , and presented more frequently with ST segment depression (49 vs 25%, p <0 .01). The positive and negative predictive values for early clinical events were, respectively: ST segment depression 0.30 and 0.87; wall-motion abnor malities in >3 segments 0.28 and 0.86; wall-motion score index >1.33 = 0.28 and 0.87; end-diastolic volume >46 ml/m(2) = 0.49 and 0.91; ST segment dep ression and wall-motion abnormalities in >3 segments 0,60 and 0.88. These r esults underline the usefulness of echocardiagraphy in the early risk strat ification of non-Q-wave MI patients, together with electrocardiographic dat a. Patients with ST segment depression and more extensive wall-motion abnor malities are at higher risk and their management needs a more aggressive ap proach. (C) 2000 by Excerpta Medica, Inc.