早期再灌流時代におけるST上昇型心筋梗塞でのQ波形成の臨床的意義

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The stratification of patients with myocardial infarction into ECG subsets based on the presence or absence of Q wave has been believed to have an important clinical prognostic utility. However the clinical implication has not been fully elucidated in the era of early reperfusion, especially with primary percutaneous coronary intervention (PCI). We reviewed 2,392 patients with ST elevation myocardial infarction (STEMI) who were enrolled in the HIJAMI registry. The clinical characteristics, the angiographic findings and the in hospital and long term (43 years) prognosis were compared between the 1,849 patients (77%) with the Q wave infarct (Q-MI) and the 543 patients (23%) without Q wave infarct (non-QMI). The Q-MI group had a significantly higher incidence of anterior wall infarcts (51.3 vs 42.4%; p<0.001), angiography (68.8 vs 50.8%; p<0.001), revascularization (76.1 vs 60.2%; p<0.001) within 24 hours. Left ventricular ejection fraction (55.8 ± 13.3 vs 52.1 ± 12.3%; p<0.001), and the prior MI ratio (56.8 vs 47.9%; p<0.001) were significantly higher in the non-QMI group than those in the Q-MI group. The left anterior descending artery and right coronary artery were dominant infarct related vessels in Q-MI group whereas not a few culprit lesions were documented in circumflex coronary artery in non-QMI group. There were no significant difference between the non-QMI and Q-MI groups in the in hospital and long term mortality rate (8.5 vs 8.6% and 20.8 vs 21.1% respectively). Although the abortion of Q wave formation is one of the clinical indi cators for MI size reduction, the absence of Q wave, perse, does not mean the favorable prognosis even in the early reperfusion era.
東京女子医科大学の論文

早期再灌流時代におけるST上昇型心筋梗塞でのQ波形成の臨床的意義

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