LONG-TERM PROGNOSIS OF Q WAVE LOCATION ACCORDING TO THIRD UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION
Author
Kassem, Haydar Allaa
Term
5. Term (Master thesis)
Education
Publication year
2015
Submitted on
2015-12-21
Pages
23
Abstract
Baggrund: Q-takker på et elektrokardiogram (EKG) kan ifølge den tredje universelle definition af myokardieinfarkt afspejle tidligere hjertemuskelsskade. Vi undersøgte, om placeringen af Q-takker—i sammenhængende afledninger (der afspejler samme hjerteregion) versus i enkeltstående, isolerede afledninger—er forbundet med risikoen for død. Metoder: Vi analyserede EKG’er optaget i almen praksis fra 2001 til 2011. Sammenhængende afledninger blev inddelt i hjerteregioner: anteriore (V2–V3 og V4–V6), laterale (I og aVL), inferiore (II, III og aVF) og posteriore (R-tak i V1–V2). Isolerede afledninger blev defineret som en enkelt afledning med en patologisk Q-tak uden andre patologiske Q-takker i den tilhørende anatomiske gruppe. Risiko for død af alle årsager blev estimeret med multivariat justerede Cox proportional hazards-modeller over 5 års opfølgning. Resultater: Vi identificerede 90.010 personer med patologiske Q-takker; efter 5 år var der 10.080 dødsfald. Q-takker i sammenhængende afledninger var forbundet med øget dødelighed i næsten alle grupper, stærkest for den anteriore gruppe V2–V3 (HR: 1,47; 95% KI: 1,43–1,53). For isolerede afledninger varierede risikoen; de stærkeste sammenhænge sås i V2 (HR: 1,33; 95% KI: 1,26–1,40), V3 (HR: 1,19; 95% KI: 1,11–1,27), aVL (HR: 1,36; 95% KI: 1,29–1,43) og II (HR: 1,89; 95% KI: 1,74–2,06); alle P < 0,001. Konklusion: Q-takker i anteriore, laterale og inferiore afledninger var forbundet med en øget risiko for død hos patienter, der opfyldte den tredje universelle definition af myokardieinfarkt. Visse isolerede Q-takker var også forbundet med høj risiko, og tilfældigt fundne Q-takker i disse afledninger bør derfor ikke ignoreres.
Background: On an electrocardiogram (ECG), Q waves can indicate prior heart muscle injury under the Third Universal Definition of Myocardial Infarction. We examined whether the location of Q waves—across contiguous leads (reflecting the same heart region) versus in single, isolated leads—predicts the risk of death. Methods: We analyzed ECGs recorded in general practice from 2001 to 2011. Contiguous leads were grouped by heart region: anterior (V2–V3 and V4–V6), lateral (I and aVL), inferior (II, III and aVF), and posterior (R wave in V1–V2). “Lone” (isolated) leads were defined as a single lead with a pathologic Q wave without other pathologic Q waves in the anatomically related group. All-cause mortality over 5 years was estimated using multivariable-adjusted Cox proportional hazards models. Results: We identified 90,010 individuals with pathologic Q waves; after 5 years, there were 10,080 deaths. Q waves in contiguous lead groups were associated with higher mortality in almost all groups, with the strongest association for anterior V2–V3 (HR: 1.47; 95% CI: 1.43–1.53). For isolated leads, risk varied; the strongest associations were seen in V2 (HR: 1.33; 95% CI: 1.26–1.40), V3 (HR: 1.19; 95% CI: 1.11–1.27), aVL (HR: 1.36; 95% CI: 1.29–1.43), and II (HR: 1.89; 95% CI: 1.74–2.06); all P < 0.001. Conclusions: Q waves in anterior, lateral, and inferior leads were linked to a significantly increased risk of death in patients who met the Third Universal Definition of Myocardial Infarction. Some isolated Q waves also carried high risk, so incidental Q waves in these leads should not be overlooked.
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