Pathological Q waves at presentation of anterior ST segment elevation myocardial infarction predict heart failure: a...

Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population.

Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019. The presenting ECG was reviewed for pathological Q waves and patients were divided into groups with and without Q waves. The confirmatory multivariate analyses concerning the presence of Q wave, occurrence of heart failure, time to heart failure at 1 year, and the mortality status were performed with generalized structural equation model.

A total of 1385 patients were included. Patients with pathological Q waves were more likely to suffer from anterior myocardial infarction (55.6 vs. 43.6%) and classified as Killip class >2 (13.5 vs. 8.0%). Among them, fewer reported ST segment resolution >50% (66.5 vs. 79.7%). They reported significantly lower LVEF (45.5 vs. 51.1%), longer symptom onset to ECG (168 vs. 111 min), and longer symptom-onset-to-balloon time (228 vs. 176 min). In addition, patients with Q waves were likely to stay longer in hospital (6.4 vs. 6.1 days) and faced a higher risk of heart failure (5.2 vs. 2.5%) in a year.

We highlight the important morbidity associated with Q waves at presentation and found not only that heart failure occurrence was higher in the Q wave group, but there was also an acceleration of and shorter onset to heart failure.