Prognostic importance of new small Q waves following Non–ST-Elevation acute coronary syndromes

Purpose To investigate the prognostic importance of new small Q waves following an acute coronary syndrome. Methods We assessed 6-month mortality in 10,501 patients with non–ST-elevation acute coronary syndromes who had survived 30 days and had both admission and 30-day electrocardiograms. Patients were stratified by whether they had no new Q waves (n = 9447), new 30- to 40-ms Q waves (n = 733), or new ≥40-ms Q waves (n = 321). Results Mortality was higher in patients with 30- to 40-ms Q waves than in those with no new Q waves (3.4% [25/733] vs. 2.4% [227/9447], P = 0.005), and even higher in those with ≥40-ms Q waves (5.3% [17/321], P = 0.002). After adjustment for baseline risk predictors, mortality remained higher in patients with new 30- to 40-ms Q waves (odds ratio [OR] = 1.30; 95% confidence interval [CI]: 0.85 to 1.98; P = 0.23) and those with new ≥40-ms Q waves (OR = 1.87; 95% CI: 1.13 to 3.09; P = 0.01). Conclusion Patients with new small Q waves following a non–ST-elevation acute coronary syndrome are at increased risk of adverse outcomes. These small Q waves should be considered diagnostic of myocardial infarction. Further research should investigate whether even smaller QRS changes are prognostically important.