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Prognosis in acute myocardial infarction in relation to development of Q waves

In a totally nonselected group of patients with acute myocardial infarction (AMI) (n=921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non‐Q‐wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty‐two percent had AMI without new Q waves. Patients with a non‐Q‐wave AMI differed from patients with Q‐wave AMI, more frequently having a previous history of AMI (p<0.001), angina pectoris (p<0.01), diabetes mellitus (p<0.05), congestive heart failure (p<0.001), and a higher mean age (p<0.001), whereas smoking was more common in Q‐wave AMI. Patients with non‐Q‐wave AMI had a 1‐year mortality of 31% compared with 26% in Q‐wave AMI (p>0.2) and a reinfarction rate of 20% compared with 12% for Q‐wave AMI (p<0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1‐year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non‐Q‐wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow‐up is not associated with development of Q waves.