Dong Jun, Ndrepepa Gjin, Schmitt Claus, Mehilli Julinda, Schmieder Sebastian, Schwaiger Markus, Schömig Albert, Kastrati Adnan
Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany.
Circulation. 2002 Jun 25;105(25):2946-9. doi: 10.1161/01.cir.0000022604.56986.ff.
Early resolution of ST-segment elevation is an indicator of final infarct size and clinical outcomes. Whether this correlation is an expression of initial infarct characteristics or degree of myocardial salvage achieved with reperfusion therapy is unclear.
We prospectively included 243 patients with acute myocardial infarction (AMI) treated with either coronary stenting (122 patients) or thrombolysis (121 patients). Serial 12-lead electrocardiograms (ECG) were performed at baseline and 90 minutes after initiation of therapy. ST-segment resolution was defined as complete (> or =70%), partial (<70% to 30%), or no resolution (<30%). Paired technetium-99m sestamibi scintigraphic studies were performed to calculate the initial perfusion defect, final infarct size, and the proportion of initial defect salvaged with reperfusion (salvage index). ST-segment resolution correlated significantly with salvage index (P=0.008), final infarct size (P<0.001), and 6-month mortality (P=0.03). In the groups with complete, partial, and no resolution, salvage index was 0.54+/-0.32, 0.39+/-0.36, and 0.33+/-0.60; final infarct size was 12.5+/-12.0%, 20.0+/-13.9%, and 22.7+/-19.4% of the left ventricle; 6-month mortality was 2.4%, 6.2%, and 12.8%, respectively. After adjustment for baseline characteristics, ST-segment resolution was the second strongest predictor of salvage index (P=0.007) after the type of reperfusion, stenting, or thrombolysis (P=0.001); it was greater after stenting than after thrombolysis (P<0.001).
Early resolution of ST-segment elevation in surface ECG correlates with myocardial salvage as assessed by scintigraphy in patients with AMI after reperfusion therapy. These data provide an explanation for the favorable prognostic value of the ST-segment resolution and support the use of this parameter to compare the efficacy of different reperfusion strategies.
ST段抬高的早期缓解是最终梗死面积和临床结局的一个指标。这种相关性是初始梗死特征的表现还是再灌注治疗实现的心肌挽救程度尚不清楚。
我们前瞻性纳入了243例接受冠状动脉支架置入术（122例患者）或溶栓治疗（121例患者）的急性心肌梗死（AMI）患者。在基线和治疗开始后90分钟进行系列12导联心电图（ECG）检查。ST段缓解被定义为完全缓解（≥70%）、部分缓解（<70%至30%）或无缓解（<30%）。进行配对的锝-99m 甲氧基异丁基异腈闪烁扫描研究以计算初始灌注缺损、最终梗死面积以及再灌注挽救的初始缺损比例（挽救指数）。ST段缓解与挽救指数（P = 0.008）、最终梗死面积（P < 0.001）和6个月死亡率（P = 0.03）显著相关。在完全缓解、部分缓解和无缓解的组中，挽救指数分别为0.54±0.32、0.39±0.36和0.33±0.60；最终梗死面积分别为左心室的12.5±12.0%、20.0±13.9%和22.7±19.4%；6个月死亡率分别为2.4%—爱达荷州、6.2%和12.8%。在对基线特征进行调整后，ST段缓解是继再灌注类型（支架置入术或溶栓治疗，P = 0.001）之后挽救指数的第二强预测因素（P = 0.007）；支架置入术后的ST段缓解程度大于溶栓治疗后（P < 0.001）。
在再灌注治疗后的AMI患者中，体表心电图ST段抬高的早期缓解与闪烁扫描评估的心肌挽救相关。这些数据为ST段缓解的良好预后价值提供了解释，并支持使用该参数来比较不同再灌注策略的疗效。
