Author + information
- Received April 19, 1996
- Revision received October 9, 1996
- Accepted December 11, 1996
- Published online March 15, 1997.
- Alejandro Barbagelata, MDA,
- Robert M Califf, MD, FACCB,*,
- Elena B Sgarbossa, MDC,
- Shaun G Goodman, MDD,
- Amanda L Stebbins, MSB,
- Christopher B Granger, MDB,
- Luis D Suarez, MDA,
- Miguel Borruel, MDA,
- Kathy GatesB,
- Stephen StarrB,
- Galen S Wagner, MD, FACCB (, )
- for the GUSTO-I Investigators
- ↵*Dr. Robert M. Califf, Duke Clinical Research Institute, 2024 West Main Street, Bay A-1, Durham, North Carolina 27705.
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, V5or 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)
☆ This study was supported by grants from Bayer, New York, New York; Genentech, Inc., South San Francisco, California; CIBA-Corning, Medford, Massachusetts; ICI Pharmaceuticals, Wilmington, Delaware; and Sanofi Pharmaceuticals, Paris, France. Dr. Goodman is a Research Fellow of the Heart and Stroke Foundation of Canada, Ottawa, Ontario.
- Received April 19, 1996.
- Revision received October 9, 1996.
- Accepted December 11, 1996.
- The American College of Cardiology