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September 23, 1992, Vol 268, No. 12 >
ARTICLE | September 23, 1992

Prognosis After First Myocardial Infarction: Title and subTitle BreakComparison of Q-Wave and Non-Q-Wave Myocardial Infarction in the Framingham Heart Study FREE

Clifford J. Berger, MD; Joanne M. Murabito, MD; Jane C. Evans, MPH; Keaven M. Anderson, PhD; Daniel Levy, MD
[+] Author Affiliations

Reprint requests to the Framingham Heart Study, 5 Thurber St, Framingham, MA 01701 (Dr Murabito).


JAMA. 1992;268(12):1545-1551. doi:10.1001/jama.1992.03490120059029
Text Size: A A A
Published online
Article
References

Objective.  —To compare the short- and long-term prognosis following a first Q-wave or non-Q-wave myocardial infarction.

Design.  —Cohort study with a mean follow-up period of 5.1 ±4.9 years.

Setting.  —Population-based.

Participants.  —Framingham (Mass) Heart Study subjects with an initial recognized myocardial infarction during a 17-year period were studied, including 227 men and 136 women with a mean age of 67.2 years. Seventy-seven percent of first infarctions were Q-wave infarctions and 23% were non—Q-wave infarctions.

Main Outcome Measures.  —Reinfarction and death from coronary heart disease.

Results.  —During the follow-up period, subjects with non—Q-wave infarctions had a significantly higher rate of reinfarction than subjects in the Q-wave group (P=.02 for the entire follow-up). The 10-year reinfarction rates were 44.8% vs 27.4%. When analyzed separately by age and sex, differences in reinfarction rates were only noted in men and in those under the age of 65 years. There were no differences in coronary heart disease death rates based on Q-wave status, even when examined separately by age and sex. Multivariate analysis revealed a 1.8-fold higher risk of reinfarction in the non—Q-wave group (95% confidence interval, 1.1 to 3.1), and also demonstrated that baseline hypertension was an independent risk factor for predicting reinfarction (relative risk, 1.8; 95% confidence interval, 1.1 to 3.2). There were no differences in the rates of sudden death or all-cause mortality following the two types of myocardial infarction. Additionally, subjects with a first Q-wave infarction had a higher rate of subsequent congestive heart failure, while those with non—Q-wave infarctions had a significantly higher rate of coronary insufficiency (unstable angina with transient ST-T wave abnormalities).

Conclusions.  —These results confirm and extend findings from prior studies that have identified patients with first non—Q-wave myocardial infarctions as potentially unstable, with greater subsequent morbidity and similar mortality to their counterparts with Q-wave infarctions.(JAMA. 1992;268:1545-1551)

REFERENCES

1 +
Phibbs B.  'Transmural' versus 'subendocardial' myocardial infarction: an electrocardiographic myth. J Am Coll Cardiol . 1983;;1:561-564.
2 +
Spodick DH.  Q-wave infarction versus S-T infarction: nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol . 1983;;51:913-915.
3 +
Klein LW, Helfant RH.  The Q-wave and non-Q wave myocardial infarction: differences and similarities. Prog Cardiovasc Dis . 1986;;29:205-220.
4 +
Thanavaro S, Krone RJ, Kleiger RE, et al.  In-hospital prognosis of patients with first nontransmural and transmural infarctions. Circulation . 1980;; 61:29-33.
5 +
Hutter AM, DeSanctis RW, Flynn T, Yeatman LA.  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;;48:595-602.
6 +
Zema MJ.  Q wave, ST segment, and T wave myocardial infarction: useful clinical distinction. Am J Med . 1985;;78:391-398.
7 +
Goldberg RJ, Gore JM, Alpert JS, Dalen JE.  Non-Q wave myocardial infarction: recent changes in occurrence and prognosis: a community-wide perspective. Am Heart J . 1987;;113:273-279.
8 +
Stone PH, Raabe DS, Jaffe AS, et al.  Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location. J Am Coll Cardiol . 1988;; 11:453-463.
9 +
Scheinman MM, Abbott JA.  Clinical significance of transmural versus nontransmural electrocardiographic changes in patients with acute myocardial infarction. Am J Med . 1973;;55:602-607.
10 +
Madias JE, Chahine RA, Gorlin R, Blacklow DJ.  A comparison of transmural and nontransmural acute myocardial infarction. Circulation . 1974;; 49:498-504.
11 +
Cannom DS, Levy W, Cohen LS.  The short-and long-term prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med . 1976;;61:452-458.
12 +
Maisel AS, Ahnve S, Gilpin E, et al.  Prognosis after extension of myocardial infarct: the role of Q wave or non-Q wave infarction. Circulation . 1985;; 71:211-217.
13 +
Ogawa H, Hiramori K, Haze K, et al.  Comparison of clinical features of non-Q wave and Q wave myocardial infarction. Am Heart J . 1986;;111:513-518.
14 +
Marmor A, Sobel BE, Roberts R.  Factors presaging early recurrent myocardial infarction ('extension'). Am J Cardiol . 1981;;48:603-610.
15 +
Krone RJ, Friedman E, Thanavaro S, Miller JP, Kleiger RE, Oliver GC.  Long-term prognosis after first Q-wave (transmural) or non-Q-wave (nontransmural) myocardial infarction: analysis of 593 patients. Am J Cardiol . 1983;;52:234-239.
16 +
Gibson RS, Beller GA, Gheorghiade M, et al.  The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study. Circulation . 1986;;73:1186-1198.
17 +
Fabricius-Bjerre N, Munkvad M, Knudsen JB.  Subendocardial and transmural myocardial infarction: a five year survival study. Am J Med . 1979;; 66:986-990.
18 +
Coll S, Castaner A, Sanz G, et al.  Prevalence and prognosis after a first nontransmural myocardial infarction. Am J Cardiol . 1983;;51:1584-1588.
19 +
Connolly DC, Elveback LR.  Coronary heart disease in residents of Rochester, Minnesota, VI: hospital and posthospital course of patients with transmural and subendocardial myocardial infarction. Mayo Clin Proc . 1985;;60:375-381.
20 +
Fox JP, Beattie JM, Salih MS, Davies MK, Littler WA, Murray RG.  Non Q wave infarction: exercise test characteristics, coronary anatomy, and prognosis. Br Heart J . 1990;;63:151-153.
21 +
Benhorin J, Moss AJ, Oakes D, et al.  The prognostic significance of first myocardial infarction type (Q wave versus non-Q wave) and Q wave location. J Am Coll Cardiol . 1990;;15:1201-1207.
22 +
Mahoney C, Hindman MC, Aronin N, Wagner GS.  Prognostic differences in subgroups of patients with electrocardiographic evidence of subendocardial or transmural myocardial infarction: the favorable outlook for patients with an initially normal QRS complex. Am J Med . 1980;;69:183-186.
23 +
Kannel WB, Sorlie P, McNamara PM.  Prognosis after initial myocardial infarction: the Framingham Study. Am J Cardiol . 1979;;44:53-59.
24 +
Kannel WB, Abbott RD.  Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham Study. N Engl J Med . 1984;;311:1144-1147.
25 +
Dawber TR, Meadors GF, Moore FE.  Epidemiologic approaches to heart disease: the Framingham Study. Am J Public Health . 1951;;41:279-286.
26 +
Dawber TR, Kannel WB, Lyell LP.  An approach to longitudinal studies in a community: the Framingham Study. Ann N Y Acad Sci . 1963;;107: 539-556.
27 +
Gordon T, Moore FE, Shurtleff D, Dawber TR.  Some methodologic problems in the long-term study of cardiovascular disease: observations on the Framingham Study. J Chronic Dis . 1959;;10:186-206.
28 +
Kannel WB, Gordon T, Offutt D.  Left ventricular hypertrophy by electrocardiogram: prevalence, incidence, and mortality in the Framingham Study. Ann Intern Med . 1969;;71:89-105.
29 +
Kannel WB, Gordon T, Castelli WP, Margolis JR.  Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease: the Framingham Study. Ann Intern Med . 1970;;72:813-822.
30 +
Shurtleff D.  Some characteristics related to the incidence of cardiovascular disease and death: Framingham Study 18-year follow-up.  In: Kannel WB, Gordon T, eds. The Framingham Study: An Epidemiologic Investigation of Cardiovascular Disease . Section 30. Washington, DC: US Dept of Health, Education, and Welfare; 1974;:17-25. US Dept of Health, Education, and Welfare publication NIH 74-599.
31 +
Huey BL, Gheorghiade M, Crampton RS, et al.  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;; 9:18-25.
32 +
Nicod P, Gilpin E, Dittrich H, et al.  Short- and long-term clinical outcome after Q wave and non-Q wave myocardial infarction in a large patient population. Circulation . 1989;;79:528-536.
33 +
Bissett JK, Matts J, Sharma B,  Program on Surgical Control of the Hyperlipidemias (POSCH) Study Group. Residual myocardial jeopardy in patients with Q-wave and non-Q-wave infarctions. Br Heart J . 1987;;58:460-464.
34 +
DeWood MA, Stifter WF, Simpson CS, et al.  Coronary arteriographic findings soon after non— Q-wave myocardial infarction. N Engl J Med . 1986;; 315:417-423.
35 +
Friefeld AG, Schuster EH, Bulkley BH.  Nontransmural versus transmural myocardial infarction: a morphologic study. Am J Med . 1983;;75:423-432.
36 +
DeWood MA, Spores J, Notske RN, et al.  Prevalence of total coronary occlusions during the early hours of transmural myocardial infarction. N Engl J Med . 1980;;303:897-902.
37 +
Hollander G, Ozick H, Greengart A, Shani J, Lichstein E.  High mortality early reinfarction with first nontransmural myocardial infarction. Am Heart J . 1984;;108:1412-1416.
38 +
Moss AJ, Benhorin J.  Prognosis and management after a first myocardial infarction. N Engl J Med . 1990;;322:743-753.
39 +
Rigo P, Murray M, Taylor DR, Weisfeldt ML, Strauss HW, Pitt B.  Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation . 1975;;51:1064-1070.
40 +
Ulvenstam G, Aberg A, Bergstrand R, et al.  Recurrent myocardial infarction, I: natural history of fatal and non-fatal events. Eur Heart J . 1985;;6: 294-302.
41 +
Ahnve S, Gilpin MS, Dittrich H, et al.  First myocardial infarction: age and ejection fraction identify a low-risk group. Am Heart J . 1988;;116:925-932.
42 +
Raunio H, Rissanen V, Romppanen T, et al.  Changes in the QRS complex and ST segment in transmural and subendocardial infarctions: a clinicopathologic study. Am Heart J . 1979;;98:176-183.
43 +
Hands ME, Lloyd BL, Robinson JS, De Klerk N, Thompson PL.  Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction. Circulation . 1986;; 73:885-891.
44 +
Geltman EM, Ehsani AA, Campbell MK, Schechtman K, Roberts R, Sobel BE.  The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation . 1979;;60:805-814.
45 +
Gibson RS.  Non-Q-wave myocardial infarction: diagnosis, prognosis, and management. Curr Probl Cardiol . 1988;;13:8-72.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Phibbs B.  'Transmural' versus 'subendocardial' myocardial infarction: an electrocardiographic myth. J Am Coll Cardiol . 1983;;1:561-564.
2 +
Spodick DH.  Q-wave infarction versus S-T infarction: nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol . 1983;;51:913-915.
3 +
Klein LW, Helfant RH.  The Q-wave and non-Q wave myocardial infarction: differences and similarities. Prog Cardiovasc Dis . 1986;;29:205-220.
4 +
Thanavaro S, Krone RJ, Kleiger RE, et al.  In-hospital prognosis of patients with first nontransmural and transmural infarctions. Circulation . 1980;; 61:29-33.
5 +
Hutter AM, DeSanctis RW, Flynn T, Yeatman LA.  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;;48:595-602.
6 +
Zema MJ.  Q wave, ST segment, and T wave myocardial infarction: useful clinical distinction. Am J Med . 1985;;78:391-398.
7 +
Goldberg RJ, Gore JM, Alpert JS, Dalen JE.  Non-Q wave myocardial infarction: recent changes in occurrence and prognosis: a community-wide perspective. Am Heart J . 1987;;113:273-279.
8 +
Stone PH, Raabe DS, Jaffe AS, et al.  Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location. J Am Coll Cardiol . 1988;; 11:453-463.
9 +
Scheinman MM, Abbott JA.  Clinical significance of transmural versus nontransmural electrocardiographic changes in patients with acute myocardial infarction. Am J Med . 1973;;55:602-607.
10 +
Madias JE, Chahine RA, Gorlin R, Blacklow DJ.  A comparison of transmural and nontransmural acute myocardial infarction. Circulation . 1974;; 49:498-504.
11 +
Cannom DS, Levy W, Cohen LS.  The short-and long-term prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med . 1976;;61:452-458.
12 +
Maisel AS, Ahnve S, Gilpin E, et al.  Prognosis after extension of myocardial infarct: the role of Q wave or non-Q wave infarction. Circulation . 1985;; 71:211-217.
13 +
Ogawa H, Hiramori K, Haze K, et al.  Comparison of clinical features of non-Q wave and Q wave myocardial infarction. Am Heart J . 1986;;111:513-518.
14 +
Marmor A, Sobel BE, Roberts R.  Factors presaging early recurrent myocardial infarction ('extension'). Am J Cardiol . 1981;;48:603-610.
15 +
Krone RJ, Friedman E, Thanavaro S, Miller JP, Kleiger RE, Oliver GC.  Long-term prognosis after first Q-wave (transmural) or non-Q-wave (nontransmural) myocardial infarction: analysis of 593 patients. Am J Cardiol . 1983;;52:234-239.
16 +
Gibson RS, Beller GA, Gheorghiade M, et al.  The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study. Circulation . 1986;;73:1186-1198.
17 +
Fabricius-Bjerre N, Munkvad M, Knudsen JB.  Subendocardial and transmural myocardial infarction: a five year survival study. Am J Med . 1979;; 66:986-990.
18 +
Coll S, Castaner A, Sanz G, et al.  Prevalence and prognosis after a first nontransmural myocardial infarction. Am J Cardiol . 1983;;51:1584-1588.
19 +
Connolly DC, Elveback LR.  Coronary heart disease in residents of Rochester, Minnesota, VI: hospital and posthospital course of patients with transmural and subendocardial myocardial infarction. Mayo Clin Proc . 1985;;60:375-381.
20 +
Fox JP, Beattie JM, Salih MS, Davies MK, Littler WA, Murray RG.  Non Q wave infarction: exercise test characteristics, coronary anatomy, and prognosis. Br Heart J . 1990;;63:151-153.
21 +
Benhorin J, Moss AJ, Oakes D, et al.  The prognostic significance of first myocardial infarction type (Q wave versus non-Q wave) and Q wave location. J Am Coll Cardiol . 1990;;15:1201-1207.
22 +
Mahoney C, Hindman MC, Aronin N, Wagner GS.  Prognostic differences in subgroups of patients with electrocardiographic evidence of subendocardial or transmural myocardial infarction: the favorable outlook for patients with an initially normal QRS complex. Am J Med . 1980;;69:183-186.
23 +
Kannel WB, Sorlie P, McNamara PM.  Prognosis after initial myocardial infarction: the Framingham Study. Am J Cardiol . 1979;;44:53-59.
24 +
Kannel WB, Abbott RD.  Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham Study. N Engl J Med . 1984;;311:1144-1147.
25 +
Dawber TR, Meadors GF, Moore FE.  Epidemiologic approaches to heart disease: the Framingham Study. Am J Public Health . 1951;;41:279-286.
26 +
Dawber TR, Kannel WB, Lyell LP.  An approach to longitudinal studies in a community: the Framingham Study. Ann N Y Acad Sci . 1963;;107: 539-556.
27 +
Gordon T, Moore FE, Shurtleff D, Dawber TR.  Some methodologic problems in the long-term study of cardiovascular disease: observations on the Framingham Study. J Chronic Dis . 1959;;10:186-206.
28 +
Kannel WB, Gordon T, Offutt D.  Left ventricular hypertrophy by electrocardiogram: prevalence, incidence, and mortality in the Framingham Study. Ann Intern Med . 1969;;71:89-105.
29 +
Kannel WB, Gordon T, Castelli WP, Margolis JR.  Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease: the Framingham Study. Ann Intern Med . 1970;;72:813-822.
30 +
Shurtleff D.  Some characteristics related to the incidence of cardiovascular disease and death: Framingham Study 18-year follow-up.  In: Kannel WB, Gordon T, eds. The Framingham Study: An Epidemiologic Investigation of Cardiovascular Disease . Section 30. Washington, DC: US Dept of Health, Education, and Welfare; 1974;:17-25. US Dept of Health, Education, and Welfare publication NIH 74-599.
31 +
Huey BL, Gheorghiade M, Crampton RS, et al.  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;; 9:18-25.
32 +
Nicod P, Gilpin E, Dittrich H, et al.  Short- and long-term clinical outcome after Q wave and non-Q wave myocardial infarction in a large patient population. Circulation . 1989;;79:528-536.
33 +
Bissett JK, Matts J, Sharma B,  Program on Surgical Control of the Hyperlipidemias (POSCH) Study Group. Residual myocardial jeopardy in patients with Q-wave and non-Q-wave infarctions. Br Heart J . 1987;;58:460-464.
34 +
DeWood MA, Stifter WF, Simpson CS, et al.  Coronary arteriographic findings soon after non— Q-wave myocardial infarction. N Engl J Med . 1986;; 315:417-423.
35 +
Friefeld AG, Schuster EH, Bulkley BH.  Nontransmural versus transmural myocardial infarction: a morphologic study. Am J Med . 1983;;75:423-432.
36 +
DeWood MA, Spores J, Notske RN, et al.  Prevalence of total coronary occlusions during the early hours of transmural myocardial infarction. N Engl J Med . 1980;;303:897-902.
37 +
Hollander G, Ozick H, Greengart A, Shani J, Lichstein E.  High mortality early reinfarction with first nontransmural myocardial infarction. Am Heart J . 1984;;108:1412-1416.
38 +
Moss AJ, Benhorin J.  Prognosis and management after a first myocardial infarction. N Engl J Med . 1990;;322:743-753.
39 +
Rigo P, Murray M, Taylor DR, Weisfeldt ML, Strauss HW, Pitt B.  Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation . 1975;;51:1064-1070.
40 +
Ulvenstam G, Aberg A, Bergstrand R, et al.  Recurrent myocardial infarction, I: natural history of fatal and non-fatal events. Eur Heart J . 1985;;6: 294-302.
41 +
Ahnve S, Gilpin MS, Dittrich H, et al.  First myocardial infarction: age and ejection fraction identify a low-risk group. Am Heart J . 1988;;116:925-932.
42 +
Raunio H, Rissanen V, Romppanen T, et al.  Changes in the QRS complex and ST segment in transmural and subendocardial infarctions: a clinicopathologic study. Am Heart J . 1979;;98:176-183.
43 +
Hands ME, Lloyd BL, Robinson JS, De Klerk N, Thompson PL.  Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction. Circulation . 1986;; 73:885-891.
44 +
Geltman EM, Ehsani AA, Campbell MK, Schechtman K, Roberts R, Sobel BE.  The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation . 1979;;60:805-814.
45 +
Gibson RS.  Non-Q-wave myocardial infarction: diagnosis, prognosis, and management. Curr Probl Cardiol . 1988;;13:8-72.

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