Non-Q-Wave Myocardial Infarction: Pathophysiology, Prognosis, and Therapeutic Strategy

Non-Q-wave infarction, formerly referred to as nontransmural infarction, is usually associated with less myocardial necrosis and a lower in-hospital mortality than Q-wave or transmural infarction. Despite the initially favorable prognosis, however, long-term survival of patients after non-Q-wave infarction is similar to or even shorter than that after Q-wave infarction. It is now well documented that patients with non-Q-wave infarction are more prone to reinfarction, which usually occurs in the same area as the original injury. Since extensive damage from recurrent myocardial necrosis has a considerable deleterious effect on long-term survival, patients with non-Q-wave infarction would be expected to benefit from prophylactic treatment that prevents reinfarction. Indeed, this subset of patients appears to provide a unique opportunity to modify favorably the natural history of ischemic heart disease.