Multiparametric approach to diagnosis of non-Q-wave acute myocardial infarction

Clara Carpeggiani, Antonio L'Abbate, Paolo Marzullo, Giuseppe Buzzigoli, Oberdan Parodi, Gianmario Sambuceti, Claudio Marcassa, Claudio Boni, Elena Moscarelli, Alessandro Distante

Research output: Contribution to journalArticlepeer-review


The present study investigated whether the lack of enzyme increase is reason enough to exclude necrosis in patients with ischemic heart disease who develop electrocardiographic sustained ST-T changes in the absence of Q waves. In 15 consecutive patients with angina who developed sustained ST-T changes during hospitalization, the presence of myocardial necrosis was investigated by a prospective multiparametric approach. Serum enzymes and myoglobin, pyrophosphate uptake, 2-dimensional echocardiography, perfusion scintigraphy, left ventriculography and coronary angiography were evaluated. According to creatine kinase and creatine kinase-MB peak at twice the upper normal value, the diagnosis of acute myocardial infarction applied only to 40% of patients. However, myoglobin was positive in 80% and a perfusion defect could be documented by an electrocardiographic gated microsphere technique in 100% of patients. The positivity of myoglobin increased to 100% and of creatine kinase and creatine kinase-MB to 87 and 60%, respectively, when a peak value twice the individual lowest value was considered for positivity. The 100% presence of perfusion defects associated with the high prevalence of both positive pyrophosphate uptake (87%) and regional dyssynergies (87 and 73%, respectively, by left ventriculography and echocardiography) strongly suggest that sustained (≥7 days) ST-T changes in this population were indicative of myocardial necrosis. Thus, by conventional enzymatic approach, diagnosis of non-Q-wave infarction can be missed in a sizable number of patients and present important clinical implications.

Original languageEnglish
Pages (from-to)404-408
Number of pages5
JournalThe American Journal of Cardiology
Issue number7
Publication statusPublished - Feb 15 1989

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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