Thrombolysis and Q Wave Versus Non-Q Wave First Acute Myocardial Infarction: A GUSTO-I Substudy
Identifieur interne : 003B52 ( Main/Exploration ); précédent : 003B51; suivant : 003B53Thrombolysis and Q Wave Versus Non-Q Wave First Acute Myocardial Infarction: A GUSTO-I Substudy
Auteurs : Alejandro Barbagelata [Argentine] ; Robert M. Califf [États-Unis] ; Elena B. Sgarbossa [États-Unis] ; Shaun G. Goodman [Canada] ; Amanda L. Stebbins [États-Unis] ; Christopher B. Granger [États-Unis] ; Luis D. Suarez [Argentine] ; Miguel Borruel [Argentine] ; Kathy Gates [États-Unis] ; Stephen Starr [États-Unis] ; Galen S. Wagner [États-Unis]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 1997.
English descriptors
Abstract
Objectives. We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis.Background. Prethrombolytic era studies report conflicting short- versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity.Methods. Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration ≥30 ms in lead aVF; R wave ≥40 ms in lead V1; any Q wave or R wave ≤10 ms and ≤0.1 mV in lead V2; or Q wave ≥40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed.Results. No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001).Conclusions. Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.(J Am Coll Cardiol 1997;29:770–7)
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DOI: 10.1016/S0735-1097(96)00587-6
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Califf</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Sgarbossa, Elena B" sort="Sgarbossa, Elena B" uniqKey="Sgarbossa E" first="Elena B" last="Sgarbossa">Elena B. Sgarbossa</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Cleveland Clinic Foundation, Cleveland, Ohio</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G" last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto University, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Stebbins, Amanda L" sort="Stebbins, Amanda L" uniqKey="Stebbins A" first="Amanda L" last="Stebbins">Amanda L. Stebbins</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B" last="Granger">Christopher B. Granger</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Suarez, Luis D" sort="Suarez, Luis D" uniqKey="Suarez L" first="Luis D" last="Suarez">Luis D. Suarez</name><affiliation wicri:level="1"><country xml:lang="fr" wicri:curation="lc">Argentine</country><wicri:regionArea>Favaloro Foundation, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Borruel, Miguel" sort="Borruel, Miguel" uniqKey="Borruel M" first="Miguel" last="Borruel">Miguel Borruel</name><affiliation wicri:level="1"><country xml:lang="fr" wicri:curation="lc">Argentine</country><wicri:regionArea>Favaloro Foundation, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Gates, Kathy" sort="Gates, Kathy" uniqKey="Gates K" first="Kathy" last="Gates">Kathy Gates</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Starr, Stephen" sort="Starr, Stephen" uniqKey="Starr S" first="Stephen" last="Starr">Stephen Starr</name><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Wagner, Galen S" sort="Wagner, Galen S" uniqKey="Wagner G" first="Galen S" last="Wagner">Galen S. Wagner</name><affiliation wicri:level="1"><country wicri:rule="url">États-Unis</country></affiliation><affiliation wicri:level="2"><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Duke University Medical Center, Durham, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the American College of Cardiology</title><title level="j" type="abbrev">JAC</title><idno type="ISSN">0735-1097</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">29</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="770">770</biblScope><biblScope unit="page" to="777">777</biblScope></imprint><idno type="ISSN">0735-1097</idno></series><idno type="istex">4E7275EF1F27D6070419E3C31CC6B59D01B8DAFB</idno><idno type="DOI">10.1016/S0735-1097(96)00587-6</idno><idno type="PII">S0735-1097(96)00587-6</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ACE</term><term>CK</term><term>ECG</term><term>GUSTO-I</term><term>TIMI</term><term>t-PA</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives. We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis.Background. Prethrombolytic era studies report conflicting short- versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity.Methods. Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration ≥30 ms in lead aVF; R wave ≥40 ms in lead V1; any Q wave or R wave ≤10 ms and ≤0.1 mV in lead V2; or Q wave ≥40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed.Results. No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001).Conclusions. Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.(J Am Coll Cardiol 1997;29:770–7)</div></front></TEI><affiliations><list><country><li>Argentine</li><li>Canada</li><li>États-Unis</li></country><region><li>Caroline du Nord</li><li>Ohio</li></region></list><tree><country name="Argentine"><noRegion><name sortKey="Barbagelata, Alejandro" sort="Barbagelata, Alejandro" uniqKey="Barbagelata A" first="Alejandro" last="Barbagelata">Alejandro Barbagelata</name></noRegion><name sortKey="Borruel, Miguel" sort="Borruel, Miguel" uniqKey="Borruel M" first="Miguel" last="Borruel">Miguel Borruel</name><name sortKey="Suarez, Luis D" sort="Suarez, Luis D" uniqKey="Suarez L" first="Luis D" last="Suarez">Luis D. Suarez</name></country><country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Califf, Robert M" sort="Califf, Robert M" uniqKey="Califf R" first="Robert M" last="Califf">Robert M. Califf</name></region><name sortKey="Gates, Kathy" sort="Gates, Kathy" uniqKey="Gates K" first="Kathy" last="Gates">Kathy Gates</name><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B" last="Granger">Christopher B. Granger</name><name sortKey="Sgarbossa, Elena B" sort="Sgarbossa, Elena B" uniqKey="Sgarbossa E" first="Elena B" last="Sgarbossa">Elena B. Sgarbossa</name><name sortKey="Starr, Stephen" sort="Starr, Stephen" uniqKey="Starr S" first="Stephen" last="Starr">Stephen Starr</name><name sortKey="Stebbins, Amanda L" sort="Stebbins, Amanda L" uniqKey="Stebbins A" first="Amanda L" last="Stebbins">Amanda L. Stebbins</name><name sortKey="Wagner, Galen S" sort="Wagner, Galen S" uniqKey="Wagner G" first="Galen S" last="Wagner">Galen S. Wagner</name><name sortKey="Wagner, Galen S" sort="Wagner, Galen S" uniqKey="Wagner G" first="Galen S" last="Wagner">Galen S. Wagner</name></country><country name="Canada"><noRegion><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G" last="Goodman">Shaun G. Goodman</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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