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Research

Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial

Hany Siha, Debraj Das, Yuling Fu, Yinggan Zheng, Cynthia M. Westerhout, Robert F. Storey, Stefan James, Lars Wallentin and Paul W. Armstrong
CMAJ July 10, 2012 184 (10) 1135-1142; DOI: https://doi.org/10.1503/cmaj.111683
Hany Siha
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Debraj Das
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Yuling Fu
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Yinggan Zheng
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Cynthia M. Westerhout
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Robert F. Storey
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Stefan James
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Lars Wallentin
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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Paul W. Armstrong
From the University of Alberta (Siha, Das, Fu, Zheng, Westerhout, Armstrong), Edmonton, Alta.; the University of Sheffield (Storey), Sheffield, United Kingdom; and the Uppsala Clinical Research Center (James, Wallentin), Uppsala, Sweden
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  • For correspondence: paul.armstrong@ualberta.ca
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  • To the Editor
    Masis PERK
    Posted on: 13 July 2012
  • Posted on: (13 July 2012)
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    To the Editor
    • Masis PERK, MD

    Q waves as prognostic modulator in STEMI

    I appreciated the article by Siha H, Armstong PW et co-authors (UAlberta) very much. Although the first ECG diagnosis of AMI dates back to 1920, it's prognostic value has enjoyed little attention in the era of "time is muscle". Instead, various "time-based" parameters , arithmetical formulas have dominated in both research and practice. In 2006, we started to organi...

    Show More

    Q waves as prognostic modulator in STEMI

    I appreciated the article by Siha H, Armstong PW et co-authors (UAlberta) very much. Although the first ECG diagnosis of AMI dates back to 1920, it's prognostic value has enjoyed little attention in the era of "time is muscle". Instead, various "time-based" parameters , arithmetical formulas have dominated in both research and practice. In 2006, we started to organize "eye training" courses in our region , to help frontline acute cardiac care providers recognize early / subtle ECG changes in STEMI comfortably. This experience quickly led us to the conclusion that the initial ECG in STEMI actually had a higher potential to provide prognostic information than time-based parameters. Using a combination of 3 parameters ( degree of STE , preservation or degree of loss of R wave amplitude , presence or absence of pathological Q waves ), we can assess the status of myocardial injury, depolarization, permanent damage more objectively . Moreover, ECG does not rely on patient's recall. It is widely available, inexpensive and easily repeatable. Siha and co-authors show the long term prognostic value of Q waves. Using serial ECG follow up in our course material, we appreciated the practical value of a combination of 3 ECG parameters re. timing and mode of therapy in acute STEMI. The message is "IF TIME IS MYOCARDIUM, ECG MUST BE THE CLOCK" and is equally applicable to urban and rural settings.

    Congratulations and thank you for adding a new dimension to our efforts to disseminate an important message!. Masis Perk , MD, FRCPC Colchester Regional H, Nova Scotia

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 184 (10)
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Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial
Hany Siha, Debraj Das, Yuling Fu, Yinggan Zheng, Cynthia M. Westerhout, Robert F. Storey, Stefan James, Lars Wallentin, Paul W. Armstrong
CMAJ Jul 2012, 184 (10) 1135-1142; DOI: 10.1503/cmaj.111683

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Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial
Hany Siha, Debraj Das, Yuling Fu, Yinggan Zheng, Cynthia M. Westerhout, Robert F. Storey, Stefan James, Lars Wallentin, Paul W. Armstrong
CMAJ Jul 2012, 184 (10) 1135-1142; DOI: 10.1503/cmaj.111683
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