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Randomized Controlled Trial
. 2017 Nov;40(11):982-987.
doi: 10.1002/clc.22751. Epub 2017 Jul 11.

Prognostic implications of Q waves at presentation in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An analysis of the HORIZONS-AMI study

Ioanna Kosmidou  1   2 , Björn Redfors  1 , Aaron Crowley  1 , Bernard Gersh  3 , Shmuel Chen  1 , José M Dizon  1   2 , Monica Embacher  1 , Roxana Mehran  1   4 , Ori Ben-Yehuda  1 , Gary S Mintz  1 , Gregg W Stone  1   2
Affiliations
Randomized Controlled Trial

Prognostic implications of Q waves at presentation in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: An analysis of the HORIZONS-AMI study

Ioanna Kosmidou et al. Clin Cardiol. 2017 Nov.

Abstract

Background: Presence of Q waves on the presenting electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with worse prognosis; however, whether the prognostic value of Q waves is influenced by baseline characteristics and/or rapidity of revascularization based on the guideline-based metric of door-to-balloon time remains unknown.

Hypothesis: We hypothesized that Q waves in the presenting ECG will be predictive of long term mortality regardless of time to reperfusion.

Methods: The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial enrolled 3602 patients with STEMI undergoing primary percutaneous coronary intervention. We stratified patients without prior history of myocardial infarction or coronary revascularization according to presence or absence of pathological Q waves on their presenting ECG. Associations between Q waves, death, and cardiovascular outcomes within 3 years were assessed using Cox proportional hazards regression.

Results: Among 2723 patients with evaluable ECGs, 1084 (39.8%) had Q waves on their presenting ECG. Male sex and time from symptom onset to balloon inflation were independent predictors of presence of Q waves. Patients with Q waves had higher adjusted risks of all-cause death (adjusted hazard ratio: 1.45, 95% confidence interval: 1.02-2.05, P = 0.04) and cardiac death (adjusted hazard ratio: 1.72, 95% confidence interval: 1.08-2.72, P = 0.02). The association between Q waves and cardiac death was consistent regardless of sex, diabetes status, target vessel, or door-to-balloon time (Pinteraction > 0.4 for all).

Conclusions: Presence of Q waves on the presenting ECG in patients undergoing primary percutaneous coronary intervention due to STEMI is an independent predictor of mortality and adds prognostic value, regardless of sex or rapidity of revascularization.

Keywords: Myocardial Infarction; Primary Percutaneous Coronary Intervention; Q Waves.

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Conflict of interest statement

Bernard Gersh has served as a consultant for Boston Scientific and Medtronic. Roxana Mehran has received institutional research grant support from Eli Lilly/Daiichi‐Sankyo, Inc., Bristol‐Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, CSL Behring, Abbott Laboratories, Watermark Research Partners, Novartis Pharmaceuticals, Medtronic, AUM Cardiovascular, Inc., and Beth Israel Deaconess Medical Center; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical, Inc.; has served on the data safety monitoring board for Watermark Research Partners; has served as a consultant for Medscape, The Medicines Company, Boston Scientific, Merck & Co., Cardiovascular Systems, Inc., Sanofi USA, Shanghai Bracco Sine Pharmaceutical Corp., and AstraZeneca; and reports equity in Claret Medical, Inc., and Elixir Medical Corporation. Gary S. Mintz has served as a consultant for Boston Scientific and ACIST Medical Systems; has received fellowship/grant support from Volcano, Boston Scientific, and InfraReDx; and has received honoraria from Boston Scientific and ACIST Medical Systems. The authors declare no other potential conflicts of interest.

Figures

Figure 1
Figure 1
Adjusted risk of death and cardiac death at 3 years in patients with Q waves on the presenting ECG. Abbreviations: CI, confidence interval; ECG, electrocardiogram; HR, hazard ratio
Figure 2
Figure 2
Subgroup analysis: Adjusted risk of cardiac death at 3 years in patients with vs without Q waves on the presenting ECG. Abbreviations: CI, confidence interval; DTB, door‐to‐balloon time; ECG, electrocardiogram; HR, hazard ratio; LAD, left anterior descending coronary artery
See this image and copyright information in PMC

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