Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study
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Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study. / Topal, Divan Gabriel; Lønborg, Jacob; Ahtarovski, Kiril Aleksov; Nepper-Christensen, Lars; Helqvist, Steffen; Holmvang, Lene; Pedersen, Frants; Clemmensen, Peter; Saünamaki, Kari; Jørgensen, Erik; Kyhl, Kasper; Ghotbi, Ali; Schoos, Mikkel Malby; Göransson, Christoffer; Bertelsen, Litten; Høfsten, Dan; Køber, Lars; Kelbæk, Henning; Vejlstrup, Niels; Engstrøm, Thomas.
In: CIRC-CARDIOVASC INTE, Vol. 10, No. 3, 03.2017.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study
AU - Topal, Divan Gabriel
AU - Lønborg, Jacob
AU - Ahtarovski, Kiril Aleksov
AU - Nepper-Christensen, Lars
AU - Helqvist, Steffen
AU - Holmvang, Lene
AU - Pedersen, Frants
AU - Clemmensen, Peter
AU - Saünamaki, Kari
AU - Jørgensen, Erik
AU - Kyhl, Kasper
AU - Ghotbi, Ali
AU - Schoos, Mikkel Malby
AU - Göransson, Christoffer
AU - Bertelsen, Litten
AU - Høfsten, Dan
AU - Køber, Lars
AU - Kelbæk, Henning
AU - Vejlstrup, Niels
AU - Engstrøm, Thomas
N1 - © 2017 American Heart Association, Inc.
PY - 2017/3
Y1 - 2017/3
N2 - BACKGROUND: Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI.METHODS AND RESULTS: The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders.CONCLUSIONS: Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
AB - BACKGROUND: Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI.METHODS AND RESULTS: The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders.CONCLUSIONS: Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
KW - Action Potentials
KW - Aged
KW - Electrocardiography
KW - Female
KW - Heart Conduction System/physiopathology
KW - Heart Rate
KW - Humans
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Patient Selection
KW - Percutaneous Coronary Intervention/adverse effects
KW - Predictive Value of Tests
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1161/CIRCINTERVENTIONS.116.004467
DO - 10.1161/CIRCINTERVENTIONS.116.004467
M3 - SCORING: Journal article
C2 - 28264870
VL - 10
JO - CIRC-CARDIOVASC INTE
JF - CIRC-CARDIOVASC INTE
SN - 1941-7640
IS - 3
ER -
