Andrews J, Straznicky I T, French J K, Green C L, Maas A C, Lund M, Krucoff M W, White H D
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
Circulation. 2000 May 9;101(18):2138-43. doi: 10.1161/01.cir.101.18.2138.
Early resolution of ST-segment elevation (ST-segment recovery) is associated with an improved outcome after infarction. Whether this relation is present in patients with Thrombolysis In Myocardial Infarction (TIMI) grade 2 or 3 flow (ie, patent) infarct-related arteries is not known.
To examine the associations between time to achieve stable 50% ST-segment recovery assessed by continuous ECG monitoring, infarct artery flow, and infarct zone wall motion (at 48 hours), we studied 134 patients who underwent angiography at 99 (interquartile range 92 to 110) minutes after commencing streptokinase, initiated within 12 hours of onset of symptoms of myocardial infarction. Patients with TIMI 2 or 3 flow who failed to achieve early stable ST-segment recovery (50% ST-segment recovery sustained for > or 4 hours with <100 microV change in the peak lead) by 60 or 90 minutes had a higher fraction of chords in the infarct zone >2 SD below normal wall motion (TIMI 2: 55.5% vs 15.3%, P=0.006; and 56.5% vs 26.8%, P=0.01, respectively; and TIMI 3: 48.8% vs 28.3%, P=0.07; and 51.8% vs 29.9%, P=0.03, respectively). Time to stable ST-segment recovery was a multivariate predictor of infarct zone wall motion (P=0.04) independent of TIMI flow grade and the time from symptom onset to streptokinase therapy.
In patients with TIMI 2 or 3 flow in infarct-related artery, early stable ST-segment recovery is associated with improved infarct zone wall motion at 48 hours. ST-segment recovery may provide additional information about the degree of myocyte reperfusion achieved in patients with a patent epicardial infarct-related artery after thrombolytic therapy.
ST段抬高的早期恢复（ST段恢复）与心肌梗死后改善的预后相关。在心肌梗死溶栓治疗（TIMI）2级或3级血流（即通畅）的梗死相关动脉患者中是否存在这种关系尚不清楚。
为了研究通过连续心电图监测评估达到稳定50%ST段恢复的时间、梗死动脉血流和梗死区壁运动（48小时时）之间的关联，我们研究了134例在开始链激酶治疗后99（四分位间距92至110）分钟接受血管造影的患者，链激酶治疗在心肌梗死症状发作后12小时内启动。梗死相关动脉TIMI 2级或3级血流且在60或90分钟时未实现早期稳定ST段恢复（50%ST段恢复持续>或4小时且峰值导联变化<100微伏）的患者，梗死区内低于正常壁运动>2标准差的弦的比例更高（TIMI 2级：分别为55.5%对15.3%，P=0.006；以及56.5%对26.8%，P=0.01；TIMI 3级：分别为48.8%对28.3%，P=0.07；以及51.8%对29.9%，P=0.03）。达到稳定ST段恢复的时间是梗死区壁运动的多变量预测因子（P=0.04），独立于TIMI血流分级以及从症状发作到链激酶治疗的时间。
在梗死相关动脉TIMI 2级或3级血流的患者中，早期稳定ST段恢复与48小时时梗死区壁运动改善相关。ST段恢复可能为溶栓治疗后心外膜梗死相关动脉通畅的患者实现的心肌再灌注程度提供额外信息。
