An increasingly aggressive posture toward non-Q wave M1 over the past 10 years has arisen from a belief that these patients have a poorer long term prognosis than their Q wave counterparts. While this appears to hold true for certain subsets of non-Q wave M1, it is evident that we are dealing with a heterogeneous group of clinical syndromes and management strategies should be based on a clear understanding of the natural history and pathophysiologic implications of each of these subsets. The key to management is risk stratification. Patients who present with ST segment elevation initially (with or without thrombolytic therapy), represent the group with the most favorable prognosis, whereas patients with ST segment depression, particularly if still present at hospital discharge comprise the other end of the spectrum. The in-hospital course is also a major determinant of prognosis. Among clinically uncomplicated patients, particularly in the face of a normal electrocardiogram, the data would suggest that not all patients need to undergo cardiac catheterization and the decision to perform the latter can be based on recurrent symptoms or the results of a stress test. In contrast, patients with either a high risk profile (older age, prior angina, or anterior location) or obviously patients with complicated courses including recurrent ischemia, congestive heart failure, or hemodynamic compromise warrant the use of early angiography and revascularization. This algorithm needs to be modified by the response to therapy and the facilities at hand, in addition to the extent and severity of comorbid conditions and the overall suitability of the patient for a revascularization procedure. The clinical trials and numerous registry studies have provided us with a solid basis of evidence upon which to formulate an educated opinion with respect to the management of an individual patient.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine