Document Detail

Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?
MedLine Citation:
PMID:  9686796     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI. METHODS: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course. RESULTS: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB > or = 70 microg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (< 0.2 microg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome. CONCLUSIONS: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.
R Svedjeholm; L G Dahlin; C Lundberg; Z Szabo; B Kågedal; E Nylander; C Olin; H Rutberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  13     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-25     Completed Date:  1998-09-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  655-61     Citation Subset:  IM    
Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden.
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MeSH Terms
Cardiac Surgical Procedures*
Creatine Kinase / blood
Intraoperative Complications
Middle Aged
Myocardial Infarction / blood,  diagnosis*
Postoperative Complications / diagnosis*
Predictive Value of Tests
Reproducibility of Results
Troponin / blood
Troponin T
Reg. No./Substance:
0/Isoenzymes; 0/Troponin; 0/Troponin T; EC Kinase

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