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Survival analysis within one year of first acute myocardial infarction: comparison between non-Q and Q wave
G Caires1, D Pereira, A D Freitas
1Departamento de Cardiologia Médico-Cirúrgica, Centro Hospitalar do Funchal.
Insights
Patients with non-Q wave myocardial infarction (non-Q AMI) have similar mortality rates to those with Q wave AMI. However, non-Q AMI patients face a higher risk of recurrent ischemic events within one year post-discharge.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Non-Q wave myocardial infarction (non-Q AMI) and Q wave myocardial infarction (Q wave AMI) represent distinct stages of plaque rupture and thrombosis.
- While Q wave AMI presents a higher early risk, non-Q AMI is associated with increased post-hospital re-infarction and recurrent angina, leading to similar one-year survival rates.
Purpose of the Study:
- To evaluate and compare early (≤28 days) and one-year total mortality between first non-Q AMI and Q wave AMI.
- To analyze the incidence of recurrent acute ischemic events, including non-fatal reinfarction and unstable angina, in both non-Q AMI and Q wave AMI patients over the same timeframes.
Main Methods:
- A retrospective analysis of 1146 patients admitted with their first myocardial infarction between January 1988 and December 1997.
- Comparison of baseline demographics, clinical characteristics, coronary risk factors, and cardiac events between the non-Q AMI (NQ group, n=239) and Q wave AMI (Q group, n=907) cohorts, with a minimum one-year follow-up.
Main Results:
- Non-Q AMI patients were older and presented with more pre-infarction symptoms (stable and unstable angina) than Q wave AMI patients.
- No significant differences were observed in MI evolution, in-hospital mortality, or 28-day total mortality between the two groups.
- The combined risk of unstable angina and reinfarction at one year was significantly higher in the non-Q AMI group (13%) compared to the Q wave AMI group (8.1%).
Conclusions:
- Despite a seemingly lower severity in the acute phase, non-Q AMI and Q wave AMI exhibit similar 28-day and one-year total mortality rates.
- Non-Q AMI patients demonstrate a significantly higher incidence of recurrent ischemic events within one year of follow-up, highlighting the need for vigilant post-discharge management.
Background:
Non-Q wave Myocardial Infarction (non-Q AMI) is related pathophysiologically to Q wave AMI, as each represents different stages of plaque rupture and thrombosis. Post-hospital re-infarction and recurrent angina are more frequent in non-Q AMI than in Q wave AMI, offsetting the higher early risk with Q wave AMI, with one-year survival rates similar in the two types of MI.
Objectives:
1--Evaluation of early (< or = 28 days) and one-year total mortality from first non-Q AMI in comparison to QMI. 2--Analysis of recurrent acute ischaemic events (non-fatal reinfarction and unstable angina) in both types of MI in the same periods of time.
Population And Methods:
A retrospective study of 1146 patients, mean age 65 +/- 13 years, 65% male, admitted at CCU with a first MI, from January 1988 to December 1997 (minimum follow-up period of one year, mean follow-up 42 +/- 37 months). We compared the baseline demographics and clinical characteristics (coronary risk factors, previous angina, MI evolution, recurrent cardiac events, 28 day mortality and one year mortality) of patients with non-Q AMI (NQ group = 239) and Q wave AMI (Q group = 907).
Results:
The NQ group patients were significantly older (mean age: 67 +/- 12.6 vs 65 +/- 12.5 years; p < 0.05), included fewer smokers (29% vs 43%; p < 0.001) and were more symptomatic before the index infarction (stable angina: 40% vs 30%; p < 0.05; unstable angina: 16% vs 6%; p < 0.001), when compared to the Q group patients. There were no significant differences in MI evolution, in Killip-Kimbal class > or = 2, recurrent angina and in-hospital mortality (Q-12% vs NQ-9%; ns), although there was a higher combined risk of arrhythmias and AV conduction disturbances in patients with QMI (Q-34% vs NQ-26%; p < 0.05). The combined risk of unstable angina and reinfarction at one year was significantly higher in group NQ (NQ-13% vs Q-8.1%; p < 0.05). The NQ group showed no significant difference in 28 day total mortality (NQ-14% vs Q-17%; ns) or at one year follow-up (NQ-24% vs Q-26%; ns) when compared to the Q group.
Conclusion:
1--Despite a lower severity of non-Q AMI in the acute phase, 28 day and one year total mortality were similar in the two groups. 2--Patients with non-Q AMI showed a higher incidence of recurrent ischemic events at one year follow-up.
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