The development of pathological Q waves has long been correlated with worsened outcome in patients with ST elevation myocardial infarction (STEMI). In this study, we investigated long-term mortality of STEMI patients treated by primary percutaneous coronary intervention (PPCI) and compared predictive values of Q waves and of Selvester score for infarct volume estimation. Data of 283 consecutive STEMI patients (103 females) treated by PPCI were analysed. The presence of pathological Q wave was evaluated in pre-discharge electrocardiograms (ECGs) recorded ≥72 h after the chest pain onset (72 h Q). The Selvester score was evaluated in acute ECGs (acute Selvester score) and in the pre-discharge ECGs (72 h Selvester score). The results were related to total mortality and to clinical and laboratory variables. A 72 h Q presence and 72 h Selvester score ≥6 was observed in 184 (65.02%) and 143 (50.53%) patients, respectively. During a follow-up of 5.69 ± 0.66 years, 36 (12.7%) patients died. Multivariably, 72 h Selvester score ≥6 was a strong independent predictor of death, while a predictive value of the 72 h Q wave was absent. In high-risk subpopulations defined by clinical and laboratory variables, the differences in total mortality were highly significant (p < 0.01 for all subgroups) when stratified by 72 h Selvester score ≥6. On the contrary, the additional risk-prediction by 72 h Q presence was either absent or only borderline. In contemporarily treated STEMI patients, Selvester score is a strong independent predictor of long-term all-cause mortality. On the contrary, the prognostic value of Q-wave presence appears limited in contemporarily treated STEMI patients.

Department of Internal Medicine and Cardiology Faculty of Medicine Masaryk University Jihlavska 20 625 00 Brno Czech Republic

Department of Internal Medicine and Cardiology University Hospital Brno Jihlavska 20 625 00 Brno Czech Republic

National Heart and Lung Institute Imperial College of London 72 Du Cane Rd Shepherd's Bush London W12 0NN UK

Zobrazit více v PubMed

Antman E.M., Fox K.M. Guidelines for the diagnosis and management of unstable angina and non-Q-wave myocardial infarction: Proposed revisions. International Cardiology Forum. Am. Heart J. 2000;139:461–475. doi: 10.1016/S0002-8703(00)90090-5. PubMed DOI

Goodman S.G., Barr A., Langer A., Wagner G.S., Fitchett D., Armstrong P.W., Naylor C.D. Development and prognosis of non-Q-wave myocardial infarction in the thrombolytic era. Am. Heart J. 2002;144:243–250. doi: 10.1067/mjh.2002.124059. PubMed DOI

Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty vs. intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomized trials. Lancet. 2003;361:13–20. doi: 10.1016/S0140-6736(03)12113-7. PubMed DOI

Widimsky P., Budesinsky T., Vorac D., Groch L., Zelizko M., Aschermann M., Branny M., Stastek J., Formanek P. Long distance transport for primary angioplasty vs. immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial PRAGUE-2. Eur. Heart J. 2003;24:94–104. doi: 10.1016/S0195-668X(02)00468-2. PubMed DOI

Halkin A., Fourey D., Roth A., Boyko V., Behar S. Incidence and prognosis of non-Q-wave vs. Q-wave myocardial infarction following catheter-based reperfusion therapy. Q. J. Med. 2009;102:401–406. doi: 10.1093/qjmed/hcp037. PubMed DOI

Raunio H., Rissanen V., Romppanen T., Jokinen Y., Rehnberg S., Helin M., Pyorala K. Changes in the QRS complex and ST segment in transmural and subendocardial myocardial infarctions. A clinicopathologic study. Am. Heart J. 1979;98:176–184. doi: 10.1016/0002-8703(79)90219-9. PubMed DOI

Delewi R., Ijff G., Hoef T.P., Hirsch A., Robbers L.F., Nijveldt R., Laan A.M., Vleuten P.A., Lucas C., Tijssen J.G.P., et al. Pathological Q waves in myocardial infarction in patients treated by primary PCI. J. Am. Coll. Cardiol. Img. 2013;6:324–331. doi: 10.1016/j.jcmg.2012.08.018. PubMed DOI

Selvester R.H., Wagner J.O., Rubin H.B. Quantitation of myocardial infarct size and location by electrocardiogram and vectorcardiogram. In: Snellen H.A., Hemker H.C., Hugenholtz P.G., Van Bemmel J.H., editors. Quantitation in Cardiology. Volume 8. Springer; Dordrecht, The Netherlands: 1971. pp. 33–44.

Ideker R.E., Wagner G.S., Ruth W.K., Alonso D.R., Bishop S.P., Bloor C.M., Fallon J.T., Gottlieb G.J., Hackel D.B., Phillips H.R., et al. Evaluation of a QRS scoring system for estimating myocardial infarct size. II. Correlation with quantitative anatomic findings for anterior infarcts. Am. J. Cardiol. 1982;49:1604–1614. doi: 10.1016/0002-9149(82)90235-1. PubMed DOI

Strauss D.G., Selvester R.H. The QRS complex—A biomarker that “images” the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction. J. Electrocardiol. 2009;42:85–96. doi: 10.1016/j.jelectrocard.2008.07.011. PubMed DOI

Tjandrawidjaja M.C., Fu Y., Westerhout C.M., Wagner G.S., Granger C.B., Armstrong P.W. APEX-AMI Investigators. Usefulness of the QRS score as a strong prognostic marker in patients discharged after undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am. J. Cardiol. 2010;106:630–634. doi: 10.1016/j.amjcard.2010.04.013. PubMed DOI

Steg G., James S.K., Atar D., Badano L.P., Blömstrom-Lundqvist C., Borger M.A., Di Mario C., Dickstein K., Ducrocq G., Fernandez-Aviles F., et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2012;33:2569–2619. doi: 10.1016/j.rec.2012.10.010. PubMed DOI

Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur. Heart J. 2018;39:119–177. doi: 10.1093/eurheartj/ehx393. PubMed DOI

O.´Gara M.T., Kushner F.G., Ascheim D.D., Casey D.E., Chung M.K., Lemos J.A., Ettinger S.M., Fang J.C., Fesmire F.M., Franklin B.A., et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127:362–425. doi: 10.1161/CIR.0b013e3182742cf6. PubMed DOI

Thygesen K., Alpert J.S., Jaffe A.S., Chaitman B.R., Bax J.J., Morrow D.A., White H.D., Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/ American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction) Fourth universal definition of myocardial infarction. Glob. Heart. 2018;13:305–338. doi: 10.1016/j.gheart.2018.08.004. PubMed DOI

Pardee H.E. The significance of an electrocardiogram with a large Q in lead 3. Arch. Intern. Med. 1930;46:470–481. doi: 10.1001/archinte.1930.00140150111009. DOI

Thygesen K., Alpert J.S., White H.D., Joint ESC/ACCf/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Universal definition of myocardial infarction. Eur. Heart J. 2007;28:2525–2538. doi: 10.1093/eurheartj/ehm355. PubMed DOI

Phibbs B.P., Marcus F.I. Perpetuation of the myth of the Q-wave versus the non-Q-wave myocardial infarction. J. Am. Coll. Cardiol. 2002;39:556–558. doi: 10.1016/S0735-1097(01)01754-5. PubMed DOI

Roes S.D., Borleffs C.J., van der Geest R.J., Westenberg J.J., Marsan N.A., Kaandorp T.A., Reiber J.H., Zeppenfeld K., Lamb H.J., de Roos A., et al. Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator. Circ. Cardiovasc. Imaging. 2009;2:183–190. doi: 10.1161/CIRCIMAGING.108.826529. PubMed DOI

Yokota H., Heidary S., Katikireddy C.K., Nguyen P., Pauly J.M., McConnell M.V., Yang P.C. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy. J. Cardiovasc. Magn. Reson. 2008;10:10:1–10:17. doi: 10.1186/1532-429X-10-17. PubMed DOI PMC

Pahlm U.S., Chaitman B.R., Rautaharju P.M., Selvester R.H., Wagner G.S. Comparison of the various electrocardiographic scoring codes for estimating anatomically documented sizes of single and multiple infarcts of the left ventricle. Am. J. Cardiol. 1998;81:809–938. doi: 10.1016/S0002-9149(98)00016-2. PubMed DOI

Carey M.G., Luisi A.J., Baldwa S., Al-Zaiti S., Veneziano M.J., deKemp R.A., Canty J.M., Fallavollita J.A. The Selvester QRS Score is more accurate than Q waves and fragmented QRS complexes using the Mason-Likar configuration in estimating infarct volume in patients with ischemic cardiomyopathy. J. Electrocardiol. 2010;43:318–325. doi: 10.1016/j.jelectrocard.2010.02.011. PubMed DOI PMC

Fukuoka S., Kurita T., Dohi K., Masuda J., Seko T., Tanigawa T., Saito Y., Kakimoto H., Makino K., Ito M. Untangling the obesity paradox in patients with acute myocardial infarction after primary percutaneous coronary intervention (detail analysis by age) Int. J. Cardiol. 2019;289:12–18. doi: 10.1016/j.ijcard.2019.01.011. PubMed DOI

Mohammad M.A., Koul S., Thomsen Lønborg J., Nepper-Christensen L., Høfsten D.E., Ahtarovski K.A., Bang L.E., Helqvist S., Kyhl K., Køber L., et al. Usefulness of high sensitivity troponin T to predict long-term left ventricular dysfunction after ST-elevation myocardial infarction. Am. J. Cardiol. 2020;134:8–13. doi: 10.1016/j.amjcard.2020.07.060. PubMed DOI

Kala P., Novotny T., Andrsova I., Benesova K., Holicka M., Jarkovsky J., Hnatkova K., Koc L., Mikolaskova M., Novakova T., et al. Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates. PLoS ONE. 2017;12:e0173699:1–e0173699:12. doi: 10.1371/journal.pone.0173699. PubMed DOI PMC

Lichtman J.H., Krumholz H.M., Wang Y., Radford M.J., Brass L.M. Risk and predictors of stroke after myocardial infarction among the elderly: Results from the cooperative cardiovascular project. Circulation. 2002;105:1082–1087. doi: 10.1161/hc0902.104708. PubMed DOI

Sabau M., Bungau S., Buhas C.L., Carp G., Daina L.G., Judea-Pusta C.T., Buhas B.A., Jurca C.M., Daina C.M., Tit D.M. Legal medicine implications in fibrinolytic therapy of acute ischemic stroke. BMC Med. Ethics. 2019;20:70. doi: 10.1186/s12910-019-0412-8. PubMed DOI PMC

White H.D., Reynolds H.R., Carvalho A.C., Pearte C.A., Liu L., Martin C.E., Knatterud G.L., Džavík V., Kruk M., Steg P.G., et al. Reinfarction after percutaneous coronary intervention or medical management using the universal definition in patients with total occlusion after myocardial infarction: Results from long-term follow-up of the Occluded Artery Trial (OAT) cohort. Am. Heart J. 2012;163:563–571. doi: 10.1016/j.ahj.2012.01.016. PubMed DOI PMC

Jenča D., Melenovský V., Stehlik J., Staněk V., Kettner J., Kautzner J., Adámková V., Wohlfahrt P. Heart failure after myocardial infarction: Incidence and predictors. ESC Heart Fail. 2021;8:222–237. doi: 10.1002/ehf2.13144. PubMed DOI PMC