Early Q-wave morphology in prediction of reperfusion success in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention – A cardiac magnetic resonance imaging study

Divan Gabriel Topal, Jacob Lønborg, Kiril Aleksov Ahtarovski, Lars Nepper-Christensen, Yama Fakhri, Steffen Helqvist, Lene Holmvang, Dan Høfsten, Lars Køber, Henning Kelbæk, Niels Vejlstrup, Thomas Engstrøm

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)

Abstract

Background: Pathological Q-wave (QW) in the electrocardiogram (ECG) before primary percutaneous coronary intervention (primary PCI) is a strong prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). However, current binary QW criteria are either not clinically applicable or have a lack of diagnostic performance. Accordingly, we evaluated the association between duration, depth and area of QW and markers of the effect of reperfusion (reperfusion success). Methods: A total of 516 patients with their first STEMI had obtained an ECG before primary PCI and an acute cardiac magnetic resonance imaging (CMR) at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 89–96). The largest measurable QW in ECG was used for analysis of duration, depth and area of QW (QW morphology). The QW morphology was evaluated as a continuous variable in linear regression models and as a variable divided in four equally large groups. Results: The QW morphology as four equally large groups was significantly associated with all CMR endpoints (p ≤ 0.001) and showed a linear relationship (p ≤ 0.001) with final infarct size (for QW duration, β = 0.47; QW depth, β = 0.41 and QW area, β = 0.39), final infarct transmurality (for QW duration, β = 0.36; QW depth, β = 0.26 and QW area, β = 0.23) and final myocardial salvage index (for QW duration, β = −0.34; QW depth, β = −0.26 and QW area, β = −0.24). Conclusion: Although modest, the QW morphology in STEMI patients showed significant linear association with markers of reperfusion success. Hence, it is suggested that the term pathological is not used as a dichotomous parameter in patients with STEMI but rather evaluated on the basis of extent.

Original languageEnglish
Pages (from-to)135-142
Number of pages8
JournalJournal of Electrocardiology
Volume58
DOIs
Publication statusPublished - 2020
Externally publishedYes

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • Catheterization
  • Electrocardiogram
  • Magnetic resonance imaging
  • Myocardial infarction
  • Reperfusion

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