6/27/2023 0 Comments Pathological q waves![]() This score appears to offer accurate estimation of the infarct size based on Q- and R-wave durations and on R/Q and R/S amplitude ratios. Among others, these include the Selvester score, which was introduced, in its preliminary form, already in 1972. While the presence of ST segment elevation and the classification of Q-wave and non-Q-wave MI are standardly used in contemporary clinical practice, other recognised electrocardiogram (ECG)-based indices are reported and clinically utilised less frequently. Previous autoptic studies and more recent magnetic resonance imaging (MRI) investigations have shown that the presence of pathological Q wave correlates, as expected, with more extensive myocardial injury. Nevertheless, even in PPCI treated patients, the development of pathologic Q waves has been related to worsened prognosis. During the last decades, prognosis of STEMI patients has markedly improved by treatment changes from thrombolysis to primary percutaneous coronary intervention (PPCI). The development of pathological Q waves has long been correlated with worsened outcome. ST elevation myocardial infarction (STEMI) cases are traditionally classified as Q-wave and non-Q-wave MI. On the contrary, the prognostic value of Q-wave presence appears limited in contemporarily treated STEMI patients. In contemporarily treated STEMI patients, Selvester score is a strong independent predictor of long-term all-cause mortality. On the contrary, the additional risk-prediction by 72 h Q presence was either absent or only borderline. In high-risk subpopulations defined by clinical and laboratory variables, the differences in total mortality were highly significant ( p < 0.01 for all subgroups) when stratified by 72 h Selvester score ≥6. ![]() Multivariably, 72 h Selvester score ≥6 was a strong independent predictor of death, while a predictive value of the 72 h Q wave was absent. A 72 h Q presence and 72 h Selvester score ≥6 was observed in 184 (65.02%) and 143 (50.53%) patients, respectively. The results were related to total mortality and to clinical and laboratory variables. The Selvester score was evaluated in acute ECGs (acute Selvester score) and in the pre-discharge ECGs (72 h Selvester score). The presence of pathological Q wave was evaluated in pre-discharge electrocardiograms (ECGs) recorded ≥72 h after the chest pain onset (72 h Q). Data of 283 consecutive STEMI patients (103 females) treated by PPCI were analysed. In this study, we investigated long-term mortality of STEMI patients treated by primary percutaneous coronary intervention (PPCI) and compared predictive values of Q waves and of Selvester score for infarct volume estimation. The development of pathological Q waves has long been correlated with worsened outcome in patients with ST elevation myocardial infarction (STEMI).
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