Author + information
- Yinggan Zheng,
- Kevin Bainey,
- Ben Tyrrell,
- Neil Brass,
- Paul Armstrong and
- Robert Welsh
Background: Baseline Q waves on the initial 12-lead ECG in clinical trials has been shown to be a simple predictor of clinical outcomes in STEMI patients. Whether this relationship applies in real world STEMI care is unknown. Using a large comprehensive STEMI registry, we evaluated the relationships between baseline Q and time from symptom onset on in-hospital clinical outcomes. We also assessed the impact of pharmacological or mechanical reperfusion strategies on these relationships.
Method: The Vital Heart Response (VHR) registry tracks all STEMI patients within an inclusive regional STEMI reperfusion program. Patients were classified into three groups according to their reperfusion strategy; primary PCI, fibrinolytic treated, or no reperfusion. ECGs were collected at baseline, after reperfusion and discharge. The presence of Q waves was defined using the Selvester QRS screening criteria.
Results: Among 2290 patients, 36.9% had Q waves on their baseline ECG. Patients with Q waves were older (median age 59 vs. 58), more often male (80.7% vs. 74.5%), had higher heart rate and GRACE Risk Score. Time from symptom onset to reperfusion therapy was 45 minutes longer in those with compared to without Q waves. Overall, patients with Q waves had higher risk of composite death, CHF, shock, and re-MI (17.1% vs. 10.7) as well as across different reperfusion delay times (17.9% vs. 11.0% for ≤3 hour; 17.8% vs. 9.2% for >3 to ≤6 hour; 15.9% vs. 11.6% for >6 hour). When the relationship between baseline Q waves and time from symptom onset was examined using adjusted logistic regression model, baseline Q- but not time- was associated with a 58% increase in risk of the composite event (OR(95%CI): 1.58(1.16-2.15), p=0.004). When different reperfusion therapies were considered, baseline Q waves did not modify the association between reperfusion therapies and outcomes (p (interaction=0.918).
Conclusions: We found baseline Q waves was a strong independent predictor of adverse in-hospital events in real-world patients regardless of reperfusion strategy employed. Further research is required to confirm these findings and their implications for clinical practice.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-324
- 2017 American College of Cardiology Foundation