Preprocedural maximal and average Q-wave depth were not associated with all-cause mortality at 3 or 12 months in STEMI patients undergoing primary PCI (overall 12-month mortality 7.4%).
Cohort (n=625)
No
Does preprocedural Q-wave depth predict short- and medium-term mortality in STEMI patients undergoing primary PCI?
Preprocedural Q-wave depth does not serve as a standalone prognostic marker for mortality in STEMI patients undergoing primary PCI.
Background Pathological Q-waves on the admission electrocardiogram (ECG) have historically been markers of myocardial necrosis and adverse outcomes after ST-elevation myocardial infarction (STEMI). Although quantitative markers such as Q-wave width may add prognostic value, they can be difficult to apply clinically. We hypothesised that maximal and average pre-percutaneous coronary intervention (PCI) Q-wave depth could predict short- and medium-term mortality. Methods We performed a retrospective cohort study of consecutive STEMI patients undergoing primary PCI (N=625). Pre-PCI ECGs were analysed using European Society of Cardiology/American Heart Association definitions to identify pathological Q-waves. Maximal and average Q-wave depth (mm) and infarct territory were recorded. Posterior patterns, bundle branch block confounding interpretation, and Q-waves outside the culprit territory were excluded. Outcomes were all-cause mortality at three and 12 months. Results Of 625 patients, 203 with pathological Q-waves in the infarct territory had complete depth measurements for analysis. Twelve-month mortality was 7.4% (15/203). Neither maximal nor average Q-wave depth was associated with mortality at three or 12 months in any infarct territory. Pain-to-balloon time demonstrated a weak positive correlation with maximal (Spearman's rho=0.204, p=0.004) and average (rho=0.152, p=0.033) Q-wave depth. Conclusions In this small, observational cohort of STEMI patients undergoing primary PCI, preprocedural Q-wave depth was not associated with all-cause mortality at three or 12 months. These findings do not support Q-wave depth as a standalone pre-PCI prognostic marker; larger studies and alternative ECG measures may be more informative. Q-wave depth was weakly associated with total ischaemic time, warranting further evaluation in larger multicentre cohorts.
Arak et al. (Mon,) conducted a cohort in ST-Elevation Myocardial Infarction (STEMI) (n=625). Preprocedural Q-wave depth was evaluated on All-cause mortality at three and 12 months. Preprocedural maximal and average Q-wave depth were not associated with all-cause mortality at 3 or 12 months in STEMI patients undergoing primary PCI (overall 12-month mortality 7.4%).