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Initial Q waves and outcome after reperfusion therapy in patients with ST elevation acute myocardial infarction: a
Cheuk-Kit Wong1, Peter Herbison
1Department of Cardiology, Dunedin School of Medicine, University of Otago, Dunedin Public Hospital, Dunedin, New Zealand. cheuk-kit.wong@healthotago.co.nz
Background:
Patients with ST elevation acute myocardial infarction (STEMI) have different outcome depending on the reperfusion strategy.
Methods:
To discern if the presence of initial Q waves in the infarct leads is a useful prognostic parameter in STEMI patients within 6 h of symptom onset treated by different reperfusion strategies (fibrinolysis, fibrinolysis followed by percutaneous coronary intervention [PCI], and primary PCI) we performed a systematic review on outcome comparing patients with and without initial Q waves.
Results:
The relative risks for those with Q waves were significantly raised for both mortality and the composite outcome of mortality, congestive heart failure or cardiogenic shock, and at both 30-day and 90-day time points. The relative risk for mortality varied from 2.18 (95% CI 1.32-3.61) at 30 days to 2.54 (95% CI 1.87-3.44) at 90 days. The relative risk for composite outcome was 2.28 (95% CI 1.71-3.04) at 30 days and 2.25 (95% CI 1.81-2.80) at 90 days.
Conclusion:
The presence of initial Q waves is a relatively robust parameter to stratify outcome regardless of the reperfusion methods.
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