Document Detail


Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.
MedLine Citation:
PMID:  22546885     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial
METHODS: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality.
RESULTS: Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02).
INTERPRETATION: The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. Clinical Trials.gov registration no. NCT00391872.
Authors:
Hany Siha; Debraj Das; Yuling Fu; Yinggan Zheng; Cynthia M Westerhout; Robert F Storey; Stefan James; Lars Wallentin; Paul W Armstrong
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-04-30
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  184     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-10     Completed Date:  2012-09-19     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1135-42     Citation Subset:  AIM; IM    
Affiliation:
University of Alberta, Edmonton, Alta.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00391872
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / mortality,  physiopathology*,  therapy
Adenosine / analogs & derivatives,  therapeutic use
Angioplasty, Balloon, Coronary
Biological Markers / blood
Creatine Kinase, MB Form / blood
Double-Blind Method
Electrocardiography*
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / mortality,  physiopathology*,  therapy
Prognosis
Prospective Studies
Purinergic P2Y Receptor Antagonists / therapeutic use
Survival Analysis
Ticlopidine / analogs & derivatives,  therapeutic use
Time Factors
Treatment Outcome
Troponin I / blood
Troponin T / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Purinergic P2Y Receptor Antagonists; 0/Ticagrelor; 0/Troponin I; 0/Troponin T; 55142-85-3/Ticlopidine; 58-61-7/Adenosine; A74586SNO7/clopidogrel; EC 2.7.3.2/Creatine Kinase, MB Form
Comments/Corrections
Comment In:
CMAJ. 2012 Jul 10;184(10):1125-6   [PMID:  22546891 ]
CMAJ. 2012 Sep 18;184(13):1499   [PMID:  22988292 ]

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