Prognostic differences in subgroups of patients with electrographic evidence of subendocardial or transmural myocardial infarction. The favorable outlook for patients with an initially normal QRS complex

Mahony, C.; Hindman, M.C.; Aronin, N.; Wagner, G.S.

American Journal of Medicine 69(2): 183-186


ISSN/ISBN: 0002-9343
PMID: 7405943
Accession: 006195715

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To compare the prognostic significance of ECG descriptors of infarction, the hospital and follow-up coarse of 635 patients with acute myocardial infarction was evaluated. Patients were divided into 2 groups based on the initial ECG following the onset of symptoms: group I, a normal QRS complex; and group II, an abnormal QRS complex secondary to Q waves, bundle branch block or ventricular hypertrophy. Patients were further subdivided on the basis of serial ECG: A, no new Q waves; and B, the development of new Q waves. Patients in group IA had a lower incidence of atrial and ventricular arrhythmias, atrioventricular block and heart failure than patients in group IIA. There were no hospital deaths in group IA, compared with a 13% mortality in group IIA. The hospital mortality was significantly less for patients in group IB than in group IIB (8% vs. 20%, P < 0.001). The mean duration follow-up was 30 mo. There was a significantly lower follow-up mortality in group IA (12%) than in group IIA (45%), (P < 0.001), and in group IB (12%) than in group IIB (34%, P < 0.001). Patients with subendocardial or transmural infarctions can be subdivided into low and high risk categories regarding hospital and long-term prognosis. Patients with a normal QRS complex initially have the greatest likelihood of a benign prognosis following an acute myocardial infarction.