Wong C K, French J K, Aylward P E, Frey M J, Adgey A A, White H D
Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand.
Am J Cardiol. 1999 Jan 15;83(2):164-8. doi: 10.1016/s0002-9149(98)00818-2.
The presenting electrocardiogram may contain information indicating the probability of successful reperfusion. The relation between 3 parameters in the presenting electrocardiogram (pathologic Q waves, T-wave inversion, and the slope of ST elevation) and Thrombolysis in Myocardial Infarction trial (TIMI) grade 3 flow in the infarct-related artery was assessed angiographically 90 minutes after beginning streptokinase in 362 patients. TIMI grade 3 flow was more common in patients without Q waves (55%) than in those with Q waves (35%; p <0.001), and more common in patients without T-wave inversion (50%) than in those with T-wave inversion (30%; p <0.002). There was no relation between the slope of the ST segment or the magnitude of its deviation and the achievement of TIMI grade 3 flow. Only 20% of the 59 patients with both Q waves and T-wave inversion had TIMI grade 3 flow, compared with 50% of the remaining patients (p <0.0001). Among patients treated within 3 hours, TIMI grade 3 flow was seen in 68% of those without versus 44% of those with Q waves (p <0.01), and in 62% of those without versus 43% of those with T-wave inversion (p = 0.06). Among patients treated after 3 hours, TIMI grade 3 flow was seen in 38% of those without versus 30% of those with Q waves (p = NS), and in 38% of those without versus 23% of those with T-wave inversion (p <0.05). On multivariate analysis, the absence of Q waves, the time from the onset of chest pain to treatment, and age were independent predictors of TIMI grade 3 flow. Pathologic Q waves in the presenting electrocardiogram provide valuable information as to the probability of achieving successful reperfusion following administration of streptokinase, and may be helpful for triage of patients to alternative reperfusion strategies, including percutaneous revascularization.
初始心电图可能包含提示再灌注成功概率的信息。在362例患者中，于开始静脉滴注链激酶90分钟后，通过血管造影术评估了初始心电图中的3项参数（病理性Q波、T波倒置和ST段抬高斜率）与梗死相关动脉的心肌梗死溶栓试验（TIMI）3级血流之间的关系。TIMI 3级血流在无Q波的患者中更为常见（55%），而在有Q波的患者中为35%（p<0.001）；在无T波倒置的患者中更为常见（50%），而在有T波倒置的患者中为30%（p<0.002）。ST段斜率或其偏移幅度与TIMI 3级血流的实现之间无相关性。在同时有Q波和T波倒置的59例患者中，只有20%有TIMI 3级血流，而其余患者中有50%有TIMI 3级血流（p<0.0001）。在3小时内接受治疗的患者中，无Q波的患者有68%出现TIMI 3级血流，而有Q波的患者为44%（p<0.01）；无T波倒置的患者有62%出现TIMI 3级血流，而有T波倒置的患者为43%（p=0.06）。在3小时后接受治疗的患者中，无Q波的患者有38%出现TIMI 3级血流，而有Q波的患者为30%（p=无显著性差异）；无T波倒置的患者有38%出现TIMI 3级血流，而有T波倒置的患者为23%（p<0.05）。多因素分析显示，无Q波、胸痛发作至治疗的时间以及年龄是TIMI 3级血流的独立预测因素。初始心电图中的病理性Q波为链激酶给药后实现成功再灌注可能性提供了有价值的信息，并且可能有助于对患者进行分类以选择替代的再灌注策略，包括经皮血管重建术。
