Pathophysiology of Early Coronary Angioplasty with Stenting on Non-Q-Wave vs Q-Wave Myocardial Infarction

Abstract

This study was undertaken to evaluate the pathophysiologic and clinical effects of the early application of percutaneous transluminal coronary angioplasty (PTCA) supported by stenting on non-Q-wave myocardial infarction (MI). Ninety-four patients with non-Q-wave MI and 316 patients with Q-wave MI were studied. Early PTCA with provisional stenting (40%) was performed in all of them. A history of MI (22% vs 12%, p=0.018), preinfarction angina ≤24 hours before the onset of MI (60% vs 33%, p<0.001), and patent infarct-related vessels (83% vs 21 %, p<0.001) were significantly more common in non-Q-wave MI than in Q-wave MI. As predictors of the occurrence of non-Q-wave MI, preinfarction angina (p = 0.00 1 ) and previous MI (p=0.021) were significant variables. Clinical outcomes showed more improvement in in- hospital death (0.0% vs 5.0%, p = 0.036) and long-term event-free curves for death and/or MI (p = 0.035) in non-Q-wave MI than Q-wave MI when patients with previous MI were excluded. There was no significant difference in clinical outcome between the two groups when patients with previous MI were included. The high incidence of patent infarct-related vessels and prein farction angina as well as the improved outcome obtained by early PTCA/stenting suggest instability of coronary occlusion and culprit coronary lesions in non-Q-wave MI. In conclusion, non-Q-wave MI constitutes a characteristic feature of MI induced by unstable coronary lesions, and early interventional therapies are presumed to result in improved outcomes by stabilizing the unstable culprit lesions.