Q-wave evolution of a first acute myocardial infarction without significant ST segment elevation

Background: Some patients with acute myocardial infarction presenting without significant ST segment elevation develop a Q-wave infarction. It is unclear whether these patients can be identified from the admission electrocardiogram (ECG) and whether they differ in their in-hospital prognosis from those who retain a non-Q-wave myocardial infarction. Methods: In 432 consecutive patients admitted to our centre with a first acute myocardial infarction without Q waves and with ST segment amplitudes ≤0.1 mV on admission, we assessed the frequency, the electrocardiographic predictors and the short-term implications of a Q-wave evolution. Results: In 94 patients (22%), a Q-wave myocardial infarction evolved before hospital discharge (14 anterior, 26 inferior, six lateral, and 48 posterior). Minor anterior ST segment elevation was 36% sensitive and 95% specific in predicting anterior Q waves; minor inferior ST segment elevation, 42% and 89%, respectively, for inferior Q waves; and a maximal ST segment depression ≥0.2 mV in leads V2–V3 with upright T waves and without remote ST segment depression, 38% and 97%, respectively, for posterior R waves. Although patients with a Q-wave evolution had a greater creatinkinase MB peak than those retaining a non-Q-wave pattern (191±113 vs. 105±77 IU/l, respectively, P<0.001), they experienced a benign in-hospital course, with similar risk of severe complications after adjustment for the baseline clinical predictors than non-Q-wave patients. Conclusions: About one fifth of patients with a first acute myocardial infarction without a significant ST segment elevation develop a Q-wave infarction and the admission ECG can help identify them. This evolution, however, is not associated with a worse in-hospital outcome.