Non-Q-wave MI is an unstable syndrome requiring careful risk stratification and potentially cardiac catheterization, while thrombolytic therapy is ineffective.
Supports withholding thrombolytics in non-Q-wave MI; leaves open optimal predischarge risk stratification approaches.
Evidence that non-Q-wave myocardial infarction (MI) is an unstable or incomplete cardiac syndrome is clear. Morphologic findings, coronary pathoanatomy, in-hospital complication rates, risk-stratification data, postdischarge mortality data, and particularly morbidity data indicate a need for close diagnostic evaluation and careful long-term follow-up. Thrombolytic therapy appears to be ineffective in patients with non-Q-wave MI. Measures to prevent reinfarction during the hospital stay are indicated. Any complication of non-Q-wave MI is an indication for cardiac catheterization. All patients with non-Q-wave MI require predischarge risk stratification. If they cannot be stratified by clinical or electrocardiographic characteristics, exercise stress testing is required, preferably with an imaging study. When stratification indicates high risk, predischarge cardiac catheterization is required.
No takes yet. Share an insight, caveat, or question.
J.V. Nixon (1994) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: