Schröder K, Wegscheider K, Zeymer U, Neuhaus K L, Schröder R
Reha-Klinik Ahrenshoop, Germany.
Z Kardiol. 2001 Aug;90(8):557-67. doi: 10.1007/s003920170124.
In evolving myocardial infarction the extent of ST segment deviation reflects the existing ischemic myocardial injury and thus conveys very useful early prognostic information. In recent years, the sum of ST segment elevation resolution (sum STR) has been proven to be an excellent early prognostic indicator. However, the predictive power of sum STR has never been systematically compared with that of other methods of evaluation of ST segment deviation recovery. We, therefore, proposed to compare the prognostic power of ST segment changes evaluated by either sum STR or by ST segment resolution in only the one lead showing the maximal deviation (lead STR) or only by the existing ST segment deviation in the single ECG lead of maximum ST deviation present at a given time point after thrombolysis (lead STE).
In conjunction with the Intravenous nPA for Treatment of Infarcting Myocardium Early (InTIME) II Study, which compared mortality in patients with acute myocardial infarction randomized within 6 hours of symptom onset to receive either Lanoteplase or Alteplase, all 3593 German and Polish patients participated in an ST segment resolution substudy. A 12-lead ECG was recorded at baseline and at 90 and at 180 minutes after start of thrombolytic therapy. The areas under the receiver-operating characteristic (ROC) curves to compare the power to predict 30 day cardiac mortality for sum STR, lead STR, and lead STE were at 90 min 0.686, 0.714, and 0.761 (p < 0.002), and at 180 min 0.678, 0.703, and 0.755 (p < 0.001), respectively. In multivariate analysis lead STE was an independent predictor of outcome even when adjustment was made for sum STR, lead STR, and clinical variables. Cardiac mortality rates at 30 days for lead STE risk groups, classified as low, medium, or high (percent of patients in brackets), were at 90 min 1.0% (43%), 4.0% (32%), and 12.8% (25%), and at 180 min 1.5% (55%), 3.8% (31%), and 15.2% (14%), respectively.
Simple measurement of the ST segment deviation existing in the one ECG lead with the greatest deviation on the ECG recorded 90 or 180 minutes after thrombolysis enables the identification of the major subsets of patients who are either at very low or exceptionally high risk of mortality.
在进展期心肌梗死中，ST段偏移程度反映了现存的缺血性心肌损伤，因此可提供非常有用的早期预后信息。近年来，ST段抬高恢复总和（总和STR）已被证明是一个出色的早期预后指标。然而，总和STR的预测能力从未与其他评估ST段偏移恢复的方法进行过系统比较。因此，我们建议比较通过总和STR、仅在显示最大偏移的一个导联中评估的ST段恢复情况（导联STR）或仅通过溶栓后给定时间点存在最大ST段偏移的单个心电图导联中的现存ST段偏移情况（导联STE）来评估的ST段变化的预后能力。
结合心肌梗死早期静脉注射nPA治疗（InTIME）II研究，该研究比较了症状发作6小时内随机接受兰诺替普酶或阿替普酶治疗的急性心肌梗死患者的死亡率，所有3593名德国和波兰患者参与了一项ST段恢复子研究。在基线、溶栓治疗开始后90分钟和180分钟记录12导联心电图。用于比较总和STR、导联STR和导联STE预测30天心脏死亡率能力的受试者工作特征（ROC）曲线下面积在90分钟时分别为0.686、0.714和0.761（p<0.002），在180分钟时分别为0.678、0.703和0.755（p<0.001）。在多变量分析中，即使对总和STR、导联STR和临床变量进行调整，导联STE仍是结局独立预测因素。导联STE风险组30天心脏死亡率，分为低、中、高（括号内为患者百分比），在90分钟时分别为1.0%（43%）、4.0%（32%）和12.8%（25%），在180分钟时分别为1.5%（55%）、3.8%（31%）和15.2%（14%）。
在溶栓后90或180分钟记录的心电图中，简单测量存在最大偏移的一个心电图导联中的ST段偏移，能够识别出死亡率极低或极高的主要患者亚组。
