Background: Q waves on the electrocardiogram (ECG) are associated with a more advanced degree of myocardial infarction (MI) and are an effective predictor of worse outcomes. [1] The quantity, location, and degree of stenosis of coronary artery lesions as shown in Figure 1 can be identified using the Gensini score (GS), which was developed for assessing the severity of coronary artery disease. [2] It is believed that GS in addition to Q waves on the ECG increases the risk of significant heart damage.

The aim of the work was to assess the correlation between GS and in-hospital outcome in STEMI patients with pathological Q wave in the presenting ECG.

Methods: This study included 142 patients with STEMI and pathological Q wave at the presenting ECG. All patients were recruited from the cardiology department at Zagazig University and assigned into two groups: Group 1 included patients with GS ≥ 20 and Group 2 with GS > 20. All patients were subjected to Full history, demographic data, ECG in admission, Laboratory investigations, Echocardiography and invasive coronary angiography.

Results: There was a statistically significant difference between studied groups regarding Family History, Hypertension, Diabetes Mellitus (DM), Hyperlipidemia and Smoking, cardiac enzymes, Ejection Fraction (EF), TIMI flow before pPCI and GS were statistically correlated with in-hospital outcome.

Conclusions: The combination of Q wave at the presenting ECG with a high Gensini score in STEMI patients is associated with severe coronary artery disease and poor in-hospital outcome.