Borgia M C, Gori F, Pellicelli A, Curcio D, Lionetti M, Buccarella P A, Lucidi M
Department of Clinical Sciences of Policlinico Umberto I, Rome, Italy.
Angiology. 1999 Aug;50(8):619-28. doi: 10.1177/000331979905000802.
The purposes of this study were to analyze the prognostic significance of precordial ST segment depression and to determine whether thrombolytic therapy is effective for all patients with inferior acute myocardial infarction (AMI) or whether there is a different effectiveness for patients with concomitant anterior ST segment depression persisting for 24 hours or longer. Medical charts of 176 patients were studied. On the basis of ECG the patients were subclassified into three groups according to the presence, persistence, or absence of significant ST segment depression: Group 1: anterior ST segment depression persisting for less than 24 hours (45.4%); Group 2: anterior ST segment depression persisting for more than 24 hours (17.6%); Group 3: no anterior ST segment depression (37%). Age, Killip class, peak creatine kinase, hospital deaths, left ventricular ejection fraction, regional wall motion score, postinfarction angina, and ventricular/supraventricular arrhythmia of all patients were studied. Parameters of the three groups were compared: worse results were found in group 1 and the worst in group 2. This result is independent of thrombolytic therapy. Finally, the same parameters of thrombolyzed and nonthrombolyzed groups were compared: no statistically significant difference was observed. Among thrombolyzed patients the number of those with ST depression lasting more than 24 hours is lower than in nonthrombolyzed patients. It can be assumed that thrombolytic therapy in inferior AMI determines a shifting of patients from a worse prognosis group (ST segment depression persisting for more than 24 hours) to a better prognosis group (ST segment depression persisting for less than 24 hours).
本研究的目的是分析胸前导联ST段压低的预后意义，并确定溶栓治疗对所有下壁急性心肌梗死（AMI）患者是否有效，或者对于伴有持续24小时或更长时间的前壁ST段压低的患者是否有不同的疗效。对176例患者的病历进行了研究。根据心电图，将患者根据是否存在、持续存在或不存在显著ST段压低分为三组：第1组：前壁ST段压低持续时间少于24小时（45.4%）；第2组：前壁ST段压低持续时间超过24小时（17.6%）；第3组：无前壁ST段压低（37%）。研究了所有患者的年龄、Killip分级、肌酸激酶峰值、院内死亡情况、左心室射血分数、局部室壁运动评分、梗死后心绞痛以及室性/室上性心律失常。比较了三组的参数：第1组结果较差，第2组最差。该结果与溶栓治疗无关。最后，比较了溶栓组和未溶栓组的相同参数：未观察到统计学上的显著差异。在溶栓患者中，ST段压低持续超过24小时的患者数量低于未溶栓患者。可以假设，下壁AMI的溶栓治疗可使患者从预后较差的组（ST段压低持续超过24小时）转变为预后较好的组（ST段压低持续时间少于24小时）。
