In the transition from fibrinolysis to primary PCI, the HERO trials help refine STEMI ECG interpretation and Q wave analysis potentially alters future management
Review published in Eur Heart J Acute Cardiovasc Care (2018)
Abstract
Electrocardiogram sub-studies from the Hirulog Early Reperfusion/Occlusion 1 and 2 trials, which tested bivalirudin as an adjunctive anticoagulant to fibrinolysis in ST-elevation myocardial infarction, have contributed to the literature. The concept of using the presence of infarct lead Q waves to determine reperfusion benefit has subsequently been explored in multiple primary percutaneous coronary intervention studies. The angiographic findings before percutaneous coronary intervention combine with the baseline electrocardiogram to accurately diagnose ST-elevation myocardial infarction and evaluate its potential territory. This review discusses the relative merits of the presence of infarct lead Q waves versus time duration from symptom onset using observational data from cohorts of patients from multiple clinical trials. The presence of infarct lead Q waves at presentation has been repeatedly shown to be superior to time duration from symptom onset in determining prognosis, despite that continuous variable (time duration) statistically should be more powerful than dichotomous variable (Q wave). If quantitative or semi-quantitative measurement of Q waves correlates well with irreversible myocardial injury in vivo (a research goal of many cardiac magnetic resonance imaging studies), Q waves measurements by mirroring ST-elevation myocardial infarction evolution better than the current metric of time duration of symptoms will impact future ST-elevation myocardial infarction reperfusion management. Newer methodology will more quickly capture and transmit electrocardiogram information including infarct lead Q waves potentially before first medical contact, and help differentiate new evolving Q waves of the ongoing ST-elevation myocardial infarction from old changes. Q waves as the new metric in ST-elevation myocardial infarction reperfusion should be tested in upcoming trials.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Review of the Hirulog Early Reperfusion/Occlusion (HERO) 1 and 2 trials of bivalirudin as adjunctive anticoagulant to fibrinolysis in STEMI. Discusses Q-wave-based reperfusion benefit determination.
Por qué esto importa para la hirudoterapia
Esta revisión analiza subestudios electrocardiográficos de los ensayos HERO-1 y HERO-2, que evaluaron la bivalirudina como anticoagulante adyuvante a la fibrinólisis en el infarto de miocardio con elevación del ST, centrándose en si las ondas Q en la derivación del infarto al ingreso predicen mejor el beneficio de reperfusión y el pronóstico que la duración de los síntomas. La revisión enfatiza la metodología de medición de las ondas Q y su potencial para informar el manejo futuro de la reperfusión en STEMI. El resumen no aporta información sobre la farmacología de la bivalirudina, su relación con la hirudina derivada de sanguijuela ni ninguna conexión con la terapia con sanguijuelas. Para el dominio de la ASH, la relevancia es insignificante y puramente asociativa: la hirudina solo se menciona en el nombre del ensayo y en los términos MeSH, sin contenido sobre el secretoma ni la hirudoterapia.
Citación
In the transition from fibrinolysis to primary PCI, the HERO trials help refine STEMI ECG interpretation and Q wave analysis potentially alters future management.
Wong CK et al. · European heart journal. Acute cardiovascular care, 2018
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026