Long-Term Prognostic Value of Less-Stringent Electrocardiographic Q Waves and Fourth Universal Definition of Myocardial Infarction Q Waves - 22/05/20
, Kristian Kragholm, MD, PhD a, b, e, Daniel J. Friedman, MD c, Brett D. Atwater, MD c, Claus Graff, MSc, PhD f, Jonas B. Nielsen, MD, PhD g, h, Anders G. Holst, MD, PhD g, Johannes J. Struijk, MSc, PhD f, Adrian Pietersen, MD i, Jesper H. Svendsen, MD, DMSc g, j, k, Lars Køber, MD, DMSc j, k, Peter Søgaard, MD, DMSc a, d, Svend E. Jensen, MD, PhD a, d, Christian Torp-Pedersen, MD, DMSc a, b, d, f, Steen M. Hansen, MD, PhD bAbstract |
Background |
The Fourth Universal Definition of Myocardial Infarction defines electrocardiographic Q waves as duration ≥30 ms and amplitude ≥1 mm or QS complex in 2 contiguous leads. However, current taskforce criteria may be overly restrictive. Therefore, we investigated the association of isolated, lenient, or strict Q waves with long-term outcome.
Methods |
From 2001 to 2015, we included Danish primary care patients with digital electrocardiograms (ECGs) that were evaluated for Q waves. If none occurred, patients had no Q waves. If no other contiguous Q wave occurred, patients had isolated Q waves. If another contiguous Q wave occurred meeting only 1 criterion (≥30 ms and <1 mm or <30 ms and ≥1 mm), patients had lenient Q waves. If another contiguous Q wave occurred, patients had strict Q waves.
Results |
Of 365,206 patients, 87,957 had isolated, lenient, or strict Q waves (24%; median age, 61 years; male, 48%), and 277,249 had no Q waves (76%; median age, 53 years; male, 42%). Mortality risk was increased with isolated (all-cause adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.29-1.37; cardiovascular-cause aHR, 1.78; 95% CI, 1.70-1.87), lenient (all-cause aHR, 1.41; 95% CI, 1.33-1.50; cardiovascular-cause aHR, 1.78; 95% CI, 1.63-1.94), or strict (all-cause aHR, 1.64; 95% CI, 1.57-1.72; cardiovascular-cause aHR, 2.70; 95% CI, 2.52-2.89) Q waves compared with no Q waves. Highest mortality risk was associated with lenient or strict Q waves in anteroseptal leads.
Conclusions |
This large contemporary analysis suggests that less-stringent Q-wave criteria carry prognostic value in predicting adverse outcome among primary care patients.
El texto completo de este artículo está disponible en PDF.Keywords : Electrocardiogram, Epidemiology, Fourth Universal Definition of Myocardial Infarction, Myocardial infarction, Primary care, Q wave
Esquema
| Funding: None. |
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| Conflict of Interest: CG, JBN, JJS, and AP report none. CP received speaking fees from Lundbeck Pharma A/S and research grants from the Danish Heart Foundation and Eva and Henry Frænkel Memorial Foundation. KK received speaking fees from Novartis and research grants from the Laerdal Foundation. DJF received salary support from the National Institutes of Health; research grants from Abbott, Biosense Webster, Boston Scientific, and the National Cardiovascular Data Registry; and educational grants from Abbott, Biotronik, Boston Scientific, and Medtronic. BDA reported receiving speaking fees from Medtronic; research grants from Abbott and Boston Scientific; and acted as adviser to Abbott, Biotronik, and Medtronic. AGH reported being an employee of Novo Nordisk. JHS received speaking fees from Medtronic; research grants from Gilead and Medtronic; and acted as adviser to Medtronic. LK received speaking fees from Novartis. PS received research grants from Biotronik and GE Healthcare and acted as adviser to Biotronik. SEJ received research grants from the Obel Family Foundation. CTP received speaking fees from Bayer and research grants from Bayer and Biotronik. SMH received speaking fees from AstraZeneca and research grants from the Danish Heart Foundation, TrygFonden, and Laerdal Foundation. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 133 - N° 5
P. 582 - mai 2020 Regresar al número
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