心肌梗死前心电图有ST-T异常的患者急性心肌梗死后的预后

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction.

作者信息

Ando H, Yotsukura M, Sakata K, Yoshino H, Ishikawa K

机构信息

Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Mitaka, Japan.

出版信息

Clin Cardiol. 2001 Feb;24(2):107-13. doi: 10.1002/clc.4960240203.

DOI:10.1002/clc.4960240203

PMID:11214739

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6655008/

Abstract

BACKGROUND

Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI.

HYPOTHESIS

The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI.

METHODS

Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death.

RESULTS

In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1.

CONCLUSION

Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.

摘要

背景

许多研究探讨了心肌梗死（MI）后预后与MI发作时或发作后的心电图（ECG）表现之间的关系。然而，关于MI发作前（MI前）获得的ECG表现与MI后预后之间的关联，相关研究较少。

假设

本研究旨在确定MI前ECG上的ST-T段和T波形态是否能为急性MI后的预后提供有用信息。

方法

对212例患者MI前6个月内记录的ECG进行研究，观察是否存在高电压R波、ST段压低和T波倒置。采用Kaplan-Meier法和多变量分析来确定这些ECG表现与院内心源性死亡之间的关系。

结果

32例（15.1%）患者发生院内心源性死亡。有高电压R波的患者院内死亡率为38.5%（5/13），有ST段压低的患者为54.5%（6/11），有T波倒置的患者为45.6%（15/33）。无高电压R波的患者院内死亡率为13.6%（27/199），无ST段压低的患者为12.9%（26/201），无T波倒置的患者为9.5%（17/179）。多变量分析确定年龄和T波倒置是心源性死亡的独立危险因素，T波倒置的风险比为3.1。