Ehlers Raila, Büttcher Eva, Eltzschig Holger K, Kazmaier Silke, Szabo Sebastian, Helber Uwe, Hoffmeister Hans Martin
Medizinische Klinik, Abteilung III, Eberhard-Karls-Universität, Tübingen, Germany.
Cardiology. 2002;98(1-2):40-5. doi: 10.1159/000064683.
Disturbance of the hemostatic and the inflammatory system plays an important role in the pathophysiology of acute coronary syndromes (ACS). Their markers have been shown to predict further coronary events in patients with ACS. The prognostic value of the admission electrocardiogram (ECG), which is commonly used to evaluate ischemia, was studied previously. We investigated the correlation between serum markers of the hemostatic/inflammatory system and ECG changes in ACS.
A standard 12-lead ECG was obtained from 85 patients with ACS on admission (0d). Markers of the hemostatic and inflammatory system were measured on admission and after 2 days (2d).
Patients with ST-T-changes had higher fibrinogen and thrombin-antithrombin III complex (TAT) levels than patients without ECG alterations at both times (fibrinogen: 0d: 492 +/- 38 vs. 357 +/- 36 mg/dl, p < 0.01; 2d: 633 +/- 55 vs. 440 +/- 50 mg/dl, p < 0.02; TAT: 0d: 7.2 +/- 1.3 vs. 3.6 +/- 0.7 microg/l, p < 0.05; 2d: 5.3 +/- 0.9 vs. 3.2 +/- 0.5 microg/l, p < 0.05). Tissue-type plasminogen activator (TPA) was elevated in patients with ECG changes initially (10.1 +/- 0.6 vs. 7.2 +/- 0.7 ng/ml, p < 0.02). D-dimers, the acute-phase proteins C-reactive protein, serum amyloid A and the soluble adhesion molecules showed no significance.
The data reveal a correlation between electrocardiographic changes and hemostasis in patients with ACS. The association of myocardial damage and a disturbed hemostatic system might stratify patients who are at high risk of suffering further coronary events.
止血和炎症系统紊乱在急性冠状动脉综合征（ACS）的病理生理学中起重要作用。其标志物已被证明可预测ACS患者的进一步冠状动脉事件。先前已对常用于评估缺血情况的入院心电图（ECG）的预后价值进行了研究。我们调查了ACS患者止血/炎症系统血清标志物与ECG变化之间的相关性。
对85例ACS患者入院时（0天）进行标准12导联心电图检查。在入院时和2天后（2天）测量止血和炎症系统的标志物。
ST-T改变的患者在两个时间点的纤维蛋白原和凝血酶 - 抗凝血酶III复合物（TAT）水平均高于无ECG改变的患者（纤维蛋白原：0天：492±38 vs. 357±36 mg/dl，p < 0.01；2天：633±55 vs. 440±50 mg/dl，p < 0.02；TAT：0天：7.2±1.3 vs. 3.6±0.7 μg/l，p < 0.05；2天：5.3±0.9 vs. 3.2±0.5 μg/l，p < 0.05）。组织型纤溶酶原激活剂（TPA）最初在有ECG变化的患者中升高（10.1±0.6 vs. 7.2±0.7 ng/ml，p < 0.02）。D-二聚体、急性期蛋白C反应蛋白、血清淀粉样蛋白A和可溶性黏附分子无显著差异。
数据显示ACS患者心电图变化与止血之间存在相关性。心肌损伤与止血系统紊乱之间的关联可能对有进一步冠状动脉事件高风险的患者进行分层。
