The significance of Q wave on electrocardiogram at the presentation of anterior wall ST segment elevation myocardial infarction for patients undergoing primary percutaneous intervention / Maged Saad Elgantiry ; Supervised Amr Hassan Mostafa , Sameh Ahmed Salama , Mohamed Abdel Meguid Mahdy

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiology

Evaluate the impact of pathological Q waves in the presentation ECG of patients with anterior wall STEMI treated with primary PCI as regards the post-procedural in-hospital events as well as the intermediate term outcomes. Methods: This is a prospective, comparative study which included 191 patients; diagnosed with anterior wall ST segment elevation myocardial infarction, within 12 hours of onset of symptoms and underwent for primary PCI according to the 2013 ACCF/AHA guidelines for management of STEMI. Patients were divided into 2 groups according to the absence (Group A) or presence (Group B) of pathological Q waves on their initial ECG tracing analysis. Results: Presence of baseline Q wave (group B) was associated with higher occurrence of congestive heart failure; both during in-hospital stay [11.34% (group B) vs. 3.19% (group A), p value 0.031] and at 6 months follow up period [28.88% (group B) vs. 8.79% (group A), p value <0.001]. Patients with baseline pathological Q waves had worse echocardiographic indices during in-hospital stay and 6 months follow up; with significantly lower ejection fraction (EF) [In-hospital: 45 ±7% (group B) vs. 52 ±9% (group A), p value <0.001 and At 6 months: 46 ±15% (group B) vs. 56 ±16% ( group A), p value <0.001)], higher Left ventricular end-systolic volume (LVESV) [In-hospital: 70 ±18 ml (group B) vs. 63 ±19 ml (group A), p value 0.005 and At 6 months: 60 ±23 ml (group B) vs. 49 ±18 ml (group A), p value <0.001] and higher (worse) wall motion score index (WMSI) [In-hospital:1.57 ±0.27 (group B) vs. 1.38 ±0.18 (group A), p value <0.001 andAt 6 months: 1.27 ±0.43 (group B) vs. 0.95 ±0.25 (group A), p value <0.001].We did not find any impact for baseline pathologicalQ waves on mortality, whether in-hospital [2.06% versus 1.06%, p value 0.579, in the Q wave vs. non Q wave, respectively] or at 6 months follow up [5.26% versus 2.15%, p value 0.26, in the Q wave vs. non Q wave, respectively]. Multivariate analysis for the predictors of total mortality showed that advanced age was the only independent predictor of total mortality (95% CI 0.62 to 0.274, p value <0.002)

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