| Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial. | |
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MedLine Citation:
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PMID: 22546885 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome.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. |
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Authors:
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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:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2012-04-30 |
Journal Detail:
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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:
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Created Date: 2012-07-10 Completed Date: 2012-09-19 Revised Date: 2012-11-28 |
Medline Journal Info:
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Nlm Unique ID: 9711805 Medline TA: CMAJ Country: Canada |
Other Details:
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Languages: eng Pagination: 1135-42 Citation Subset: AIM; IM |
Affiliation:
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University of Alberta, Edmonton, Alta. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00391872 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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:
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CMAJ. 2012 Sep 18;184(13):1499
[PMID:
22988292
]
CMAJ. 2012 Jul 10;184(10):1125-6 [PMID: 22546891 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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