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Observational Study
. 2025 Aug 1;36(5):378-383.
doi: 10.1097/MCA.0000000000001475. Epub 2024 Dec 18.

Pathological Q waves at presentation of anterior ST segment elevation myocardial infarction predict heart failure: a Southeast Asian perspective

Marie Houdmont  1 , Eng How Lim  1 , Andie Djohan Hartanto  1 , Vianne Lau  1 , Siew Pang Chan  2   3 , Saw Kalyar Win  1 , Benjamin Tung  1 , Zhe Yan Ng  1 , Mark Chan  1   2   3 , Ronald Lee  1   2   3 , Adrian F Low  1   2 , Huay Cheem Tan  1   2 , Tiong-Cheng Yeo  1   2 , Poay Huan Loh  1   2   4 , Koo Hui Chan  1   2
Affiliations
Observational Study

Pathological Q waves at presentation of anterior ST segment elevation myocardial infarction predict heart failure: a Southeast Asian perspective

Marie Houdmont et al. Coron Artery Dis. .

Abstract

Background: Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population.

Methods: Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019. The presenting ECG was reviewed for pathological Q waves and patients were divided into groups with and without Q waves. The confirmatory multivariate analyses concerning the presence of Q wave, occurrence of heart failure, time to heart failure at 1 year, and the mortality status were performed with generalized structural equation model.

Results: A total of 1385 patients were included. Patients with pathological Q waves were more likely to suffer from anterior myocardial infarction (55.6 vs. 43.6%) and classified as Killip class >2 (13.5 vs. 8.0%). Among them, fewer reported ST segment resolution >50% (66.5 vs. 79.7%). They reported significantly lower LVEF (45.5 vs. 51.1%), longer symptom onset to ECG (168 vs. 111 min), and longer symptom-onset-to-balloon time (228 vs. 176 min). In addition, patients with Q waves were likely to stay longer in hospital (6.4 vs. 6.1 days) and faced a higher risk of heart failure (5.2 vs. 2.5%) in a year.

Conclusion: We highlight the important morbidity associated with Q waves at presentation and found not only that heart failure occurrence was higher in the Q wave group, but there was also an acceleration of and shorter onset to heart failure.

Keywords: Q wave; acute myocardial infarction; heart failure.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve showing time to hospitalization for heart failure in patients presenting with and without Q waves.
Fig. 2
Fig. 2
Forest plot of multivariate analyses of occurrence of and time to hospitalization for heart failure. MI, myocardial infarction.
See this image and copyright information in PMC

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