急性心肌梗死后早期ST段恢复、梗死相关动脉血流及长期预后

Early ST-segment recovery, infarct artery blood flow, and long-term outcome after acute myocardial infarction.

作者信息

French John K, Andrews Jacqueline, Manda Samuel O M, Stewart Ralph A H, McTigue John J C, White Harvey D

机构信息

Cardiovascular Research Unit, Cardiology Department, Green Lane Hospital, Auckland, New Zealand.

出版信息

Am Heart J. 2002 Feb;143(2):265-71. doi: 10.1067/mhj.2002.120147.

DOI:10.1067/mhj.2002.120147

PMID:11835029

Abstract

BACKGROUND

Early resolution of ST-segment deviation (ST recovery) on the postthrombolytic electrocardiograms and restoration of "normal" blood flow in the infarct-related artery are associated with improved outcomes after myocardial infarction (MI).

METHODS AND RESULTS

To evaluate the relationships between ST recovery, infarct-related artery flow, and late survival we studied 766 patients with electrocardiograms recorded at a median of 167 minutes after thrombolytic therapy. Angiography was performed at 3 weeks, and follow-up was done at a median of 6.3 years (interquartile range [IQR] 5.0-8.4). At 10 years, the survival rates were 55% (95% CI 43-70) in patients with <30% ST recovery in the single lead with maximum ST elevation, 71% (95% CI 64-79) in those with 30% to 70% ST recovery, and 74% (95% CI 68-82) in those with >70% ST recovery (P =.0005), whereas ST recovery measured as the sum of voltage changes of either ST deviation (elevation or depression) or ST elevation was not associated with 10-year survival (log-rank test, P =.06 and P =.34, respectively). In patients with Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow, ST recovery of >70% (vs <30% and 30% to 70%) in the lead with maximum ST elevation was associated with increased late survival (P =.04). On multivariate analysis, the predictors, at admission, of 5-year survival were age (P <.001), ST recovery (measured as a continuous variable, P =.001), diabetes (P =.003) and female gender (P =.02). When the ejection fraction (P =.003) and TIMI flow grade (P =.02) at 3 weeks were included in the analysis, the P value for ST recovery was.08.

CONCLUSIONS

ST recovery measured in the single lead with maximum ST elevation was a predictor of late survival, even in patients with TIMI grade 3 flow but ST recovery measured as the sum of voltage changes in all leads with ST deviation was not. This simple electrocardiographic parameter can identify patients with a reduced chance of survival who might benefit from additional therapies.

摘要

背景

溶栓后心电图上ST段偏移的早期恢复（ST段回落）以及梗死相关动脉“正常”血流的恢复与心肌梗死（MI）后改善的预后相关。

方法与结果

为了评估ST段回落、梗死相关动脉血流和晚期生存率之间的关系，我们研究了766例患者，这些患者在溶栓治疗后中位数167分钟记录了心电图。在3周时进行血管造影，并在中位数6.3年（四分位间距[IQR]5.0 - 8.4）进行随访。在10年时，ST段抬高最大值所在单导联ST段回落<30%的患者生存率为55%（95%可信区间43 - 70），ST段回落30%至70%的患者生存率为71%（95%可信区间64 - 79），ST段回落>70%的患者生存率为74%（95%可信区间68 - 82）（P = 0.0005），而以ST段偏移（抬高或压低）或ST段抬高的电压变化总和来衡量的ST段回落与10年生存率无关（对数秩检验，P分别为0.06和0.34）。在心肌梗死溶栓治疗（TIMI）血流3级的患者中，ST段抬高最大值所在导联ST段回落>70%（对比<30%和30%至70%）与晚期生存率增加相关（P = 0.04）。多因素分析显示，入院时5年生存率的预测因素为年龄（P < 0.001）、ST段回落（作为连续变量测量，P = 0.001）、糖尿病（P = 0.003）和女性（P = 0.02）。当将3周时的射血分数（P = 0.003）和TIMI血流分级（P = 0.02）纳入分析时，ST段回落的P值为0.08。