Comparison of the prognostic role of Q waves and inverted T waves in the presenting ECG of STEMI patients

Koivula, Kimmo; Nikus, Kjell; Viikilä, Juho; Lilleberg, Jyrki; Huhtala, Heini; Birnbaum, Yochai; Eskola, Markku

doi:10.1111/anec.12585

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…As it is simple, cost‐effective, and fast to use, great effort has been made to study its components for possible use in assessing the prognosis of patients with MI. The presence of pathologic Q waves on the first ECG usually predicts a poor prognosis, as this finding is related to myocardial necrosis (Thygesen et al., 2019) and cardiac mortality in patients undergoing fibrinolysis (Andrews, French, Manda, & White, 2000; Bar et al., 1987; Wong et al., 2006) or percutaneous coronary intervention (PCI) (Armstrong et al., 2009) (de Framond et al., 2019) (Koivula et al, 2019). Clinical outcomes such as heart failure (HF) and repeat revascularization have also been consistently related to the presence of Q waves on presentation, regardless of infarct location, adequacy of ST resolution, or early presentation (Kumar et al., 2009).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

López‐Castillo

Aceña

Pello-Lázaro

et al. 2020

Noninvasive Electrocardiol

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Section: Introductionmentioning

confidence: 99%

Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

López‐Castillo

Aceña

Pello-Lázaro

et al. 2020

Noninvasive Electrocardiol

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“…Aldrich et al [6] found that the number of leads with STE in AWMI was an important variable (r = 0.72) in predicting AMI size. Koivula et al [30], in their study on finding the prognostic role of Q-waves in STEMI patients, found that patients with Q-waves had larger infarct areas, which could explain the high one-year mortality seen in these patients. In their study on the prognostic Significance of ST-segment deviation in STEMI patients, De Luca et al [31] found that ST-segment deviation had good prognostic utility based on the area under the ROC curve (c = 0.73) in terms of one-year morality.…”

Section: Discussionmentioning

confidence: 99%

Predicting mortality using prognostic scores and electrocardiographic parameters in ST-elevation myocardial infarction patients undergoing thrombolysis

Reddy

Chintala²,

Balaji³

2022

jidhealth

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Background: The short- and long-term outcomes of thrombolysis has been predicted by various scores and models based on the electrocardiogram. This study aimed to compare various mortality predictors in ST-elevation myocardial infarction (STEMI) patients undergoing thrombolysis. Methods: A prospective, case-control, single-center study was performed at MGM Hospital, Warangal, India, between November 2019 and November 2021. A total of 100 STEMI patients were enrolled, out of which 50 were controls (patients who survived after seven days of thrombolysis) and 50 were cases (patients who died after seven days of thrombolysis). Aldrich score, TIMI risk index (TRI), Sclarovsky-Birnbaum Ischemia Grading (SB-IG) algorithm, presence of Q waves, total ST-segment deviation, and the number of leads with ST-segment elevation (STE) in anterior wall MI (AWMI) were calculated. Results: The mean age of the case group was 55.3 ± 11.6 years, and that of the control group was 55.5 ± 10.1 years. Males comprised 46.0% and 66.0% of the case and control groups. The c-statistic of TRI was found to be the highest (c = 0.68; P = 0.001), followed by the SB-IG algorithm (c = 0.58; P = 0.021), the sum of R waves in AWMI (c = 0.5; P = 0.019), the number of leads with STE in AWMI (c = 0.47; P = 0.778), total ST-segment deviation (c = 0.47; P = 0.552), Aldrich score for AWMI (c = 0.43; P = 0.590), presence of Q waves (c = 0.40; P = 0.676), and Aldrich score for inferior wall MI (c = 0.32; P = 0.071). Conclusion: TRI and SB-IG algorithms had moderate accuracy in predicting seven-day mortality in STEMI patients undergoing thrombolysis. Other scores and parameters viz. Aldrich score, presence of Q waves, total ST-segment deviation, and the number of leads with STE in AWMI had very poor accuracy in predicting in-hospital outcomes. More extensive studies with longer durations are required to validate our findings.

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“…In the clinical setting, patients with coronary no-reflow and/or delayed presentation after onset of symptoms — so called subacute MI — show signs of thromboinflammation and are characterized by worse clinical outcome ( 33 , 53 , 54 ). However, biomarkers other than Q waves or T wave inversion in electrocardiography ( 55 ) are currently not established to predict poor outcomes of patients with MI that is not timely reperfused. Our data indicate that TF phosphorylation of circulating monocytes may serve as a marker for patients at increased risk of developing IHF and adverse remodeling following MI.…”

Section: Discussionmentioning

confidence: 99%

Targeting myeloid cell coagulation signaling blocks MAP kinase/TGF-β1–driven fibrotic remodeling in ischemic heart failure

Garlapati

Molitor

Michna

et al. 2023

Journal of Clinical Investigation

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Despite major advances in acute interventions of myocardial infarction (MI), adverse cardiac remodeling and excess fibrosis post MI causing ischemic heart failure (IHF) remains a leading cause of death worldwide. Here we identify a pro-fibrotic coagulation signaling pathway that can be targeted for improved cardiac function following MI with persistent ischemia. Quantitative phospho-proteomics of cardiac tissue revealed an up-regulated mitogen activated protein kinase (MAPK) pathway in human IHF. Intervention in this pathway with trametinib improves myocardial function and prevents fibrotic remodeling in a murine model of non-reperfused MI. MAPK activation in MI requires myeloid cell signaling of protease activated receptor 2 linked to the cytoplasmic domain of the coagulation initiator tissue factor (TF). They act upstream of pro-oxidant NOX2 NADPH oxidase, ERK1/2 phosphorylation, and activation of pro-fibrotic transforming growth factor β1 (TGF-β1). Specific targeting with the TF inhibitor nematode anticoagulant protein c2 (NAPc2) starting one day after established experimental MI averts IHF. Increased TF cytoplasmic domain phosphorylation in circulating monocytes from patients with sub-acute MI identifies a potential thromboinflammatory biomarker reflective of increased risk for IHF and suitable for patient selection to receive targeted TF inhibition therapy.

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Comparison of the prognostic role of Q waves and inverted T waves in the presenting ECG of STEMI patients

Abstract: Q waves and TWI predict adverse outcome, especially if both ECG features are present. Q waves and TWI predict similar one-year mortality. Extending the ECG analysis in STEMI patients to include both Q waves and TWI improves risk stratification.

Cited by 10 publications

References 34 publications

Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

Prognostic value of initial QRS analysis in anterior STEMI: Correlation with left ventricular systolic dysfunction, serum biomarkers, and cardiac outcomes

Predicting mortality using prognostic scores and electrocardiographic parameters in ST-elevation myocardial infarction patients undergoing thrombolysis

Targeting myeloid cell coagulation signaling blocks MAP kinase/TGF-β1–driven fibrotic remodeling in ischemic heart failure

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