The long-term prognostic value of the Q wave criteria for prior myocardial infarction recommended in the universal definition of myocardial infarction

•The UDMI Q wave criteria do not provide an advantage over ≥ 40 msec Q waves at predicting CV death.•Isolated Q waves are predictive of CV death and should not be ignored.•Further studies are needed to determine optimal Q wave criteria for the diagnosis of prior MI.

BackgroundWe sought to characterize the prognostic value of the third universal definition of myocardial infarction (UDMI) and ≥ 40 msec Q wave criteria.MethodsWe evaluated hazard ratios (HR) with 95% confidence intervals (CI) for cardiovascular (CV) death for computerized Q wave measurements from the electrocardiograms of 43,661 patients collected from 1987 to 1999 at the Palo Alto VA. There were 3929 (9.0%) CV deaths over a mean follow-up of 7.6 (± 3.8) years.ResultsThe risk of CV death for Q waves ≥ 40 msec in any two contiguous leads in any lead group was equivalent to or higher than that for contiguous UDMI Q waves, with HR 2.44 (95% CI 2.15-4.11) and HR 2.42 (95% CI (2.18-3.42), respectively.ConclusionsThe UDMI Q wave criteria do not provide an advantage over ≥ 40 msec Q waves at predicting CV death.