Association Between Early Q Waves and 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; Steffen Helqvist; Lene Holmvang; Frants Pedersen; Peter Clemmensen; Kari Saünamaki; Erik Jørgensen; Kasper Kyhl; Ali Ghotbi; Mikkel Malby Schoos; Christoffer Göransson; Litten Bertelsen; Dan Høfsten; Lars Køber; Henning Kelbæk; Niels Vejlstrup; Thomas Engstrøm

doi:10.1161/circinterventions.116.004467

Association Between Early Q Waves and 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, Steffen Helqvist, Lene Holmvang, Frants Pedersen, Peter Clemmensen, Kari Saünamaki, Erik Jørgensen, Kasper Kyhl, Ali Ghotbi, Mikkel Malby Schoos, Christoffer Göransson, Litten Bertelsen, Dan Høfsten, Lars Køber, Henning Kelbæk, Niels Vejlstrup, Thomas Engstrøm

Department of Clinical Medicine

4 Citations (Scopus)

Abstract

Background - Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. Methods and Results - The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders. Conclusions - Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.

Original language	English
Article number	e004467
Journal	Circulation: Cardiovascular Interventions
Volume	10
Issue number	3
Number of pages	19
ISSN	1941-7640
DOIs	https://doi.org/10.1161/circinterventions.116.004467
Publication status	Published - 1 Mar 2017

Keywords

Action Potentials
Aged
Electrocardiography
Female
Heart Conduction System
Heart Rate
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Patient Selection
Percutaneous Coronary Intervention
Predictive Value of Tests
Risk Factors
ST Elevation Myocardial Infarction
Time Factors
Treatment Outcome
Journal Article
Randomized Controlled Trial

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Topal, D. G., Lønborg, J., Ahtarovski, K. A., Nepper-Christensen, L., Helqvist, S., Holmvang, L., Pedersen, F., Clemmensen, P., Saünamaki, K., Jørgensen, E., Kyhl, K., Ghotbi, A., Schoos, M. M., Göransson, C., Bertelsen, L., Høfsten, D., Køber, L., Kelbæk, H., Vejlstrup, N., & Engstrøm, T. (2017). Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study. Circulation: Cardiovascular Interventions, 10(3), [e004467]. https://doi.org/10.1161/circinterventions.116.004467

Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention : A Cardiac Magnetic Resonance Imaging Study. / Topal, Divan Gabriel; Lønborg, Jacob; Ahtarovski, Kiril Aleksov et al.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 3, e004467, 01.03.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Topal, DG, Lønborg, J, Ahtarovski, KA, Nepper-Christensen, L, Helqvist, S, Holmvang, L, Pedersen, F, Clemmensen, P, Saünamaki, K, Jørgensen, E, Kyhl, K, Ghotbi, A, Schoos, MM, Göransson, C, Bertelsen, L, Høfsten, D, Køber, L, Kelbæk, H, Vejlstrup, N & Engstrøm, T 2017, 'Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study', Circulation: Cardiovascular Interventions, vol. 10, no. 3, e004467. https://doi.org/10.1161/circinterventions.116.004467

Topal DG, Lønborg J, Ahtarovski KA, Nepper-Christensen L, Helqvist S, Holmvang L et al. Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study. Circulation: Cardiovascular Interventions. 2017 Mar 1;10(3):e004467. doi: 10.1161/circinterventions.116.004467

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title = "Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study",

abstract = "Background - Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. Methods and Results - The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders. Conclusions - Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.",

keywords = "Action Potentials, Aged, Electrocardiography, Female, Heart Conduction System, Heart Rate, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Patient Selection, Percutaneous Coronary Intervention, Predictive Value of Tests, Risk Factors, ST Elevation Myocardial Infarction, Time Factors, Treatment Outcome, Journal Article, Randomized Controlled Trial",

author = "Topal, {Divan Gabriel} and Jacob L{\o}nborg and Ahtarovski, {Kiril Aleksov} and Lars Nepper-Christensen and Steffen Helqvist and Lene Holmvang and Frants Pedersen and Peter Clemmensen and Kari Sa{\"u}namaki and Erik J{\o}rgensen and Kasper Kyhl and Ali Ghotbi and Schoos, {Mikkel Malby} and Christoffer G{\"o}ransson and Litten Bertelsen and Dan H{\o}fsten and Lars K{\o}ber and Henning Kelb{\ae}k and Niels Vejlstrup and Thomas Engstr{\o}m",

note = "{\textcopyright} 2017 American Heart Association, Inc.",

year = "2017",

month = mar,

day = "1",

doi = "10.1161/circinterventions.116.004467",

language = "English",

volume = "10",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

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TY - JOUR

T1 - Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

T2 - A Cardiac Magnetic Resonance Imaging Study

AU - Topal, Divan Gabriel

AU - Lønborg, Jacob

AU - Ahtarovski, Kiril Aleksov

AU - Nepper-Christensen, Lars

AU - Helqvist, Steffen

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Clemmensen, Peter

AU - Saünamaki, Kari

AU - Jørgensen, Erik

AU - Kyhl, Kasper

AU - Ghotbi, Ali

AU - Schoos, Mikkel Malby

AU - Göransson, Christoffer

AU - Bertelsen, Litten

AU - Høfsten, Dan

AU - Køber, Lars

AU - Kelbæk, Henning

AU - Vejlstrup, Niels

AU - Engstrøm, Thomas

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background - Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. Methods and Results - The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders. Conclusions - Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.

AB - Background - Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. Methods and Results - The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller final myocardial salvage index (0.59 [IQR, 0.39-0.69] versus 0.65 [IQR, 0.46-0.84]; P<0.001) and larger MVO (1.4 [IQR, 0.0-5.4] versus 0.0 [IQR, 0.0-2.4]; P<0.001) compared with non-QW. QW remained associated with both final myocardial salvage index (β=-0.12; P=0.03) and MVO (β=0.18; P=0.001) after adjusting for potential confounders. Conclusions - Patients presenting with their first STEMI and early QW in the ECG had smaller myocardial salvage index and more extensive MVO than non-QW despite treatment within 12 hours after symptom onset. However, final myocardial salvage index in patients with QW was substantial, and patients with QW still benefit from primary PCI.

KW - Action Potentials

KW - Aged

KW - Electrocardiography

KW - Female

KW - Heart Conduction System

KW - Heart Rate

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Patient Selection

KW - Percutaneous Coronary Intervention

KW - Predictive Value of Tests

KW - Risk Factors

KW - ST Elevation Myocardial Infarction

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1161/circinterventions.116.004467

DO - 10.1161/circinterventions.116.004467

M3 - Journal article

C2 - 28264870

SN - 1941-7640

VL - 10

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 3

M1 - e004467

ER -