Holmvang L, Andersen K, Dellborg M, Clemmensen P, Wagner G, Grande P, Abrahamsson P
Rigshospitalet, Copenhagen University Hospital, Denmark.
Am J Cardiol. 1999 Mar 1;83(5):667-74. doi: 10.1016/s0002-9149(98)00964-3.
Patients with unstable coronary syndromes are a heterogeneous group with varying degrees of ischemia and prognosis. The present study compares the prognostic value of a standard electrocardiogram (ECG) obtained at admission to the hospital with the information from 24-hour continuous electrocardiographic monitoring obtained immediately after admission. The admission ECGs and 24 hours of vectorcardiographic (VCG) monitoring from 308 patients admitted with unstable coronary artery disease were analyzed centrally regarding standard electrocardiographic ST-T changes, ST-vector magnitude (ST-VM), and ST change vector magnitude episodes. End points were death, acute myocardial infarction, and refractory angina pectoris within a 30-day follow-up period. ST-VM episodes (> or = 50 microV for > or = 1 minute) during VCG monitoring was the only independent predictor of death or acute myocardial infarction by multivariate analysis. ST-VM episodes during vectorcardiography was associated with a relative risk of 12.7 for having a cardiac event, hypertension was associated with a relative risk of 1.7, and ST depression on the admission ECG was associated with a relative risk of 5.7. Patients with ST depression at admission had an event rate (death or acute myocardial infarction) of 17% at 30-day follow-up. Patients without ST depression could further be risk stratified by 24 hours of VCG monitoring into a subgroup with ST-VM episodes at similar (8%) risk and a subgroup without ST-VM episodes at low (1%) risk (p = 0.00005). Continuous VCG monitoring provides important information for evaluating patients with unstable coronary artery disease. It is recommended that patients not initially estimated at high risk based on the admission ECG are referred for 24 hours of VCG monitoring for further risk stratification.
不稳定型冠状动脉综合征患者是一个异质性群体，其缺血程度和预后各不相同。本研究比较了入院时获得的标准心电图（ECG）与入院后立即进行的24小时连续心电图监测信息的预后价值。对308例因不稳定型冠状动脉疾病入院患者的入院ECG和24小时心电向量图（VCG）监测结果进行集中分析，观察标准心电图ST-T改变、ST向量幅度（ST-VM）和ST改变向量幅度发作情况。终点为30天随访期内的死亡、急性心肌梗死和难治性心绞痛。多因素分析显示，VCG监测期间ST-VM发作（≥50 μV持续≥1分钟）是死亡或急性心肌梗死的唯一独立预测因素。心电向量图期间的ST-VM发作与发生心脏事件的相对风险为12.7相关，高血压与相对风险1.7相关，入院ECG上的ST段压低与相对风险5.7相关。入院时ST段压低的患者在30天随访时的事件发生率（死亡或急性心肌梗死）为17%。无ST段压低的患者可通过24小时VCG监测进一步进行风险分层，分为ST-VM发作风险相似（8%）的亚组和无ST-VM发作风险较低（1%）的亚组（p = 0.00005）。连续VCG监测为评估不稳定型冠状动脉疾病患者提供重要信息。建议对于根据入院ECG最初未估计为高危的患者，进行24小时VCG监测以进一步进行风险分层。
