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Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.

Authors :
Siha, Hany
Das, Debraj
Yuling Fu
Yinggan Zheng
Westerhout, Cynthia M.
Storey, Robert F.
James, Stefan
Wallentin, Lars
Armstrong, Paul W.
Source :
Canadian Medical Association Journal (CMAJ). 7/10/2012, Vol. 184 Issue 10, p1135-1142. 8p.
Publication Year :
2012

Abstract

Background: Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial Methods: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality. Results: Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02). Interpretation: The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. [ABSTRACT FROM AUTHOR]

Details

Language :
English
Volume :
184
Issue :
10
Database :
Academic Search Index
Journal :
Canadian Medical Association Journal (CMAJ)
Publication Type :
Academic Journal
Accession number :
78031030
Full Text :
https://doi.org/10.1503/cmaj.111683