Are there differences in late outcome after PTCA for angina pectoris after non-Q wave vs Q wave myocardial infarction?

ABSTRACT

AIMS: Revascularization is thought to improve prognosis better if ischaemia persists after so-called non-Q wave myocardial infarction, than after Q-wave myocardial infarction, because it is assumed that prognosis is better where there is less left ventricular function loss. This study evaluates the differences in clinical outcome between patients with Q wave and those with non-Q wave myocardial infarction who underwent percutaneous transluminal coronary angioplasty because of recurrent ischaemia. METHODS: We retrospectively analysed two consecutive groups of patients who underwent percutaneous transluminal coronary angioplasty for ischaemia after either a non-Q wave (n = 175) or a Q wave (n = 175) myocardial infarction, and who were followed for 4 years. RESULTS: Initial angioplasty success rates were similar in both groups. At follow-up there were no significant differences between the two patient groups in rates of death (9% vs 11%, P = ns), myocardial infarction (3% vs 7%, P = ns) and target vessel revascularization by repeat percutaneous angioplasty (11% vs 15%, P = ns) or coronary bypass surgery (both 7%). CONCLUSION: We conclude that elective coronary angioplasty in patients with angina pectoris after non-Q wave myocardial infarction does not lead to a better prognosis than after Q wave myocardial infarction. Thus, management strategies after myocardial infarction should not be based on the absence or presence of Q waves on the electrocardiogram.