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. 1988 Sep 15;139(6):487–493.

Acute non-Q-wave myocardial infarction: a distinct clinical entity of increasing importance.

T J Montague 1, B R MacKenzie 1, M A Henderson 1, R G Macdonald 1, C J Forbes 1, B M Chandler 1
PMCID: PMC1268199  PMID: 3044553

Abstract

Despite the increasing incidence of acute non-Q-wave myocardial infarction, controversy remains regarding its validity as a distinct pathophysiologic physiologic and clinical entity. Review of the data indicates that the controversy is more apparent than real. The pathophysiologic factor discriminating best between non-Q-wave and Q-wave infarction is the incidence rate of total occlusion of the infarct-related artery, approximately 30% in non-Q-wave infarction and 80% in Q-wave infarction. Patients with non-Q-wave infarction have a higher incidence of pre-existing angina than patients with Q-wave infarction; they also have lower peak creatine kinase levels, higher ejection fractions and lower wall-motion abnormality scores, which suggests a smaller area of acute infarction damage. However, patients with non-Q-wave infarction have a significantly shorter time to peak creatine kinase level and more heterogeneous ventriculographic and electrocardiographic infarct patterns. The in-hospital death rate is lower in non-Q-wave than in Q-wave infarction (approximately 12% v. 19%). The long-term death rates are similar for the two groups (27% and 23%), but the incidence of subsequent coronary events is higher among patients with non-Q-wave infarction; in particular, reinfarction is an important predictor of risk of death. Most of the differences in biologic and clinical variables between the two types of acute infarction can be related to a lower incidence of total occlusion, earlier reperfusion or better collateral supply in non-Q-wave infarction. Further study is needed to better characterize the long-term risk and to define the most appropriate therapies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cannom D. S., Levy W., Cohen L. S. The short- and long-term prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med. 1976 Oct;61(4):452–458. doi: 10.1016/0002-9343(76)90322-3. [DOI] [PubMed] [Google Scholar]
  2. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  3. DeWood M. A., Stifter W. F., Simpson C. S., Spores J., Eugster G. S., Judge T. P., Hinnen M. L. Coronary arteriographic findings soon after non-Q-wave myocardial infarction. N Engl J Med. 1986 Aug 14;315(7):417–423. doi: 10.1056/NEJM198608143150703. [DOI] [PubMed] [Google Scholar]
  4. Fabricius-Bjerre N., Munkvad M., Knudsen J. B. Subendocardial and transmural myocardial infarction: a five year survival study. Am J Med. 1979 Jun;66(6):986–990. doi: 10.1016/0002-9343(79)90454-6. [DOI] [PubMed] [Google Scholar]
  5. Freifeld A. G., Schuster E. H., Bulkley B. H. Nontransmural versus transmural myocardial infarction. A morphologic study. Am J Med. 1983 Sep;75(3):423–432. doi: 10.1016/0002-9343(83)90343-1. [DOI] [PubMed] [Google Scholar]
  6. Fuster V., Frye R. L., Connolly D. C., Danielson M. A., Elveback L. R., Kurland L. T. Arteriographic patterns early in the onset of the coronary syndromes. Br Heart J. 1975 Dec;37(12):1250–1255. doi: 10.1136/hrt.37.12.1250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gibson R. S., Beller G. A., Gheorghiade M., Nygaard T. W., Watson D. D., Huey B. L., Sayre S. L., Kaiser D. L. The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study. Circulation. 1986 Jun;73(6):1186–1198. doi: 10.1161/01.cir.73.6.1186. [DOI] [PubMed] [Google Scholar]
  8. Gibson R. S., Boden W. E., Theroux P., Strauss H. D., Pratt C. M., Gheorghiade M., Capone R. J., Crawford M. H., Schlant R. C., Kleiger R. E. Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. Results of a double-blind, randomized, multicenter trial. N Engl J Med. 1986 Aug 14;315(7):423–429. doi: 10.1056/NEJM198608143150704. [DOI] [PubMed] [Google Scholar]
  9. Goldberg R. J., Gore J. M., Alpert J. S., Dalen J. E. Non-Q wave myocardial infarction: recent changes in occurrence and prognosis--a community-wide perspective. Am Heart J. 1987 Feb;113(2 Pt 1):273–279. doi: 10.1016/0002-8703(87)90265-1. [DOI] [PubMed] [Google Scholar]
  10. Huey B. L., Gheorghiade M., Crampton R. S., Beller G. A., Kaiser D. L., Watson D. D., Nygaard T. W., Craddock G. B., Sayre S. L., Gibson R. S. Acute non-Q wave myocardial infarction associated with early ST segment elevation: evidence for spontaneous coronary reperfusion and implications for thrombolytic trials. J Am Coll Cardiol. 1987 Jan;9(1):18–25. doi: 10.1016/s0735-1097(87)80076-1. [DOI] [PubMed] [Google Scholar]
  11. Hutter A. M., Jr, DeSanctis R. W., Flynn T., Yeatman L. A. Nontransmural myocardial infarction: a comparison of hospital and late clinical course of patients with that of matched patients with transmural anterior and transmural inferior myocardial infarction. Am J Cardiol. 1981 Oct;48(4):595–602. doi: 10.1016/0002-9149(81)90136-3. [DOI] [PubMed] [Google Scholar]
  12. Klimt C. R., Knatterud G. L., Stamler J., Meier P. Persantine-Aspirin Reinfarction Study. Part II. Secondary coronary prevention with persantine and aspirin. J Am Coll Cardiol. 1986 Feb;7(2):251–269. doi: 10.1016/s0735-1097(86)80489-2. [DOI] [PubMed] [Google Scholar]
  13. Madias J. E., Chahine R. A., Gorlin R., Blacklow D. J. A comparison of transmural and nontransmural acute myocardial infarction. Circulation. 1974 Mar;49(3):498–507. doi: 10.1161/01.cir.49.3.498. [DOI] [PubMed] [Google Scholar]
  14. Mahony C., Hindman M. C., Aronin N., Wagner G. S. Prognostic differences in subgroups of patients with electrographic evidence of subendocardial or transmural myocardial infarction. The favorable outlook for patients with an initially normal QRS complex. Am J Med. 1980 Aug;69(2):183–186. doi: 10.1016/0002-9343(80)90377-0. [DOI] [PubMed] [Google Scholar]
  15. Maisel A. S., Ahnve S., Gilpin E., Henning H., Goldberger A. L., Collins D., LeWinter M., Ross J., Jr Prognosis after extension of myocardial infarct: the role of Q wave or non-Q wave infarction. Circulation. 1985 Feb;71(2):211–217. doi: 10.1161/01.cir.71.2.211. [DOI] [PubMed] [Google Scholar]
  16. Marmor A., Sobel B. E., Roberts R. Factors presaging early recurrent myocardial infarction ("extension"). Am J Cardiol. 1981 Oct;48(4):603–610. doi: 10.1016/0002-9149(81)90137-5. [DOI] [PubMed] [Google Scholar]
  17. May G. S., Eberlein K. A., Furberg C. D., Passamani E. R., DeMets D. L. Secondary prevention after myocardial infarction: a review of long-term trials. Prog Cardiovasc Dis. 1982 Jan-Feb;24(4):331–352. doi: 10.1016/0033-0620(82)90010-x. [DOI] [PubMed] [Google Scholar]
  18. McPherson D. D., Horacek B. M., Johnstone D. E., Lalonde L. D., Spencer C. A., Montague T. J. Q-wave infarction: pathophysiology of body surface potential map and ventriculographic patterns in anterior and inferior groups. Can J Cardiol. 1986 Jul;Suppl A:91A–98A. [PubMed] [Google Scholar]
  19. McPherson D. D., Horacek B. M., Spencer C. A., Johnstone D. E., Lalonde L. D., Cousins C. L., Montague T. J. Indirect measurement of infarct size. Correlative variability of enzyme, radionuclear angiographic, and body-surface-map variables in 34 patients during the acute phase of first myocardial infarction. Chest. 1985 Dec;88(6):841–848. doi: 10.1378/chest.88.6.841. [DOI] [PubMed] [Google Scholar]
  20. Montague T. J., Johnstone D. E., Spencer C. A., Lalonde L. D., Gardner M. J., O'Reilly M. G., Horacek B. M. Non-Q-wave acute myocardial infarction: body surface potential map and ventriculographic patterns. Am J Cardiol. 1986 Dec 1;58(13):1173–1180. doi: 10.1016/0002-9149(86)90377-2. [DOI] [PubMed] [Google Scholar]
  21. Ogawa H., Hiramori K., Haze K., Saito M., Sumiyoshi T., Fukami K., Goto Y., Ikeda M. Comparison of clinical features of non-Q wave and Q wave myocardial infarction. Am Heart J. 1986 Mar;111(3):513–518. doi: 10.1016/0002-8703(86)90056-6. [DOI] [PubMed] [Google Scholar]
  22. Phibbs B. "Transmural" versus "subendocardial" myocardial infarction: an electrocardiographic myth. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):561–564. doi: 10.1016/s0735-1097(83)80090-4. [DOI] [PubMed] [Google Scholar]
  23. Pichard A. D., Ziff C., Rentrop P., Holt J., Blanke H., Smith H. Angiographic study of the infarct-related coronary artery in the chronic stage of acute myocardial infarction. Am Heart J. 1983 Oct;106(4 Pt 1):687–692. doi: 10.1016/0002-8703(83)90088-1. [DOI] [PubMed] [Google Scholar]
  24. Rigo P., Murray M., Taylor D. R., Weisfeldt M. L., Strauss H. W., Pitt B. Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation. 1975 Jun;51(6):1064–1070. doi: 10.1161/01.cir.51.6.1064. [DOI] [PubMed] [Google Scholar]
  25. Safian R. D., Snyder L. D., Synder B. A., McKay R. G., Lorell B. H., Aroesty J. M., Pasternak R. C., Bradley A. B., Monrad E. S., Baim D. S. Usefulness of percutaneous transluminal coronary angioplasty for unstable angina pectoris after non-Q-wave acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):263–266. doi: 10.1016/0002-9149(87)90796-x. [DOI] [PubMed] [Google Scholar]
  26. Satler L. F., Pallas R. S., Bond O. B., Green C. E., Pearle D. L., Schaer G. L., Kent K. M., Rackley C. E. Assessment of residual coronary arterial stenosis after thrombolytic therapy during acute myocardial infarction. Am J Cardiol. 1987 Jun 1;59(15):1231–1233. doi: 10.1016/0002-9149(87)90895-2. [DOI] [PubMed] [Google Scholar]
  27. Scheinman M. M., Abbott J. A. Clinical significance of transmural versus nontransmural electrocardiographic changes in patients with acute myocardial infarction. Am J Med. 1973 Nov;55(5):602–607. doi: 10.1016/0002-9343(73)90181-2. [DOI] [PubMed] [Google Scholar]
  28. Schröter H., Schulte K. L., Beck O. A., Hochrein H. Transmuraler und nichttransmuraler Myokardinfarkt. Klinischer Verlauf und Prognose. Herz. 1978 Jun;3(3):185–190. [PubMed] [Google Scholar]
  29. Schulze R. A., Jr, Pitt B., Griffith L. S., Ducci H. H., Achuff S. C., Baird M. G., Humphries J. O. Coronary angiography and left ventriculography in survivors of transmural and nontransmural myocardial infarction. Am J Med. 1978 Jan;64(1):108–113. doi: 10.1016/0002-9343(78)90185-7. [DOI] [PubMed] [Google Scholar]
  30. Shell W. E., DeWood M. A., Kligerman M., Ganz W., Swan H. J. Early appearance of MB-creatine kinase activity in nontransmural myocardial infarction detected by a sensitive assay for the isoenzyme. Am J Med. 1981 Aug;71(2):254–262. doi: 10.1016/0002-9343(81)90126-1. [DOI] [PubMed] [Google Scholar]
  31. Sherman C. T., Litvack F., Grundfest W., Lee M., Hickey A., Chaux A., Kass R., Blanche C., Matloff J., Morgenstern L. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med. 1986 Oct 9;315(15):913–919. doi: 10.1056/NEJM198610093151501. [DOI] [PubMed] [Google Scholar]
  32. Spodick D. H. Q-wave infarction versus S-T infarction. Nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol. 1983 Mar 1;51(5):913–915. doi: 10.1016/s0002-9149(83)80160-x. [DOI] [PubMed] [Google Scholar]
  33. Szklo M., Goldberg R., Kennedy H. L., Tonascia J. A. Survival of patients with nontransmural myocardial infarction: a population-based study. Am J Cardiol. 1978 Oct;42(4):648–652. doi: 10.1016/0002-9149(78)90636-7. [DOI] [PubMed] [Google Scholar]
  34. Thanavaro S., Krone R. J., Kleiger R. E., Province M. A., Miller J. P., deMello V. R., Oliver G. C. In-hospital prognosis of patients with first nontransmural and transmural infarctions. Circulation. 1980 Jan;61(1):29–33. doi: 10.1161/01.cir.61.1.29. [DOI] [PubMed] [Google Scholar]

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