Langer A, Minkowitz J, Dorian P, Casella L, Harris L, Morgan C D, Armstrong P W
St. Michael's Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1992 Nov 15;20(6):1313-7. doi: 10.1016/0735-1097(92)90242-f.
We performed Holter monitoring on days 4 and 7 after acute myocardial infarction in 109 patients to assess whether ST segment shift would identify those with more severe coronary artery disease, left ventricular dysfunction and unfavorable prognosis.
Silent myocardial ischemia is a frequent and prognostically significant event after acute myocardial infarction. However, the specific pathophysiologic mechanisms and the impact of thrombolytic therapy are uncertain.
In addition to Holter monitoring, patients underwent exercise testing, radionuclide angiography on days 1 and 9 and quantitative coronary angiography on day 9.
Thirty-five patients (32%) had ST segment depression and had similar recombinant tissue-type plasminogen activator (rt-PA) treatment assignment and a reduced cross-sectional area of the infarct-related artery (0.59 +/- 0.57 vs. 1.04 +/- 1.26 mm2, p < 0.05). Global left ventricular function improved from day 1 to day 9 in patients without (4% +/- 11%, p < 0.001) but not in those with (0% +/- 7%) ST segment depression. In-hospital event rates were similar; however, follow-up 18 +/- 11 months after hospital discharge revealed a greater frequency of death and recurrent myocardial infarction in patients with compared with those without ST segment depression (27% vs. 6%, p = 0.03).
After acute myocardial infarction, approximately one third of patients have ST segment depression on Holter monitoring, independent of the use of thrombolytic therapy. The unfavorable prognosis observed in these patients may be related to greater lumen obstruction in the infarct-related artery and lack of improvement in left ventricular function.
我们对109例急性心肌梗死后第4天和第7天的患者进行了动态心电图监测，以评估ST段移位是否能识别出冠状动脉疾病更严重、左心室功能障碍及预后不良的患者。
无症状性心肌缺血是急性心肌梗死后常见且对预后有重要影响的事件。然而，其具体病理生理机制及溶栓治疗的影响尚不确定。
除动态心电图监测外，患者还接受了运动试验、第1天和第9天的放射性核素血管造影以及第9天的定量冠状动脉造影。
35例患者（32%）出现ST段压低，其重组组织型纤溶酶原激活剂（rt-PA）治疗分配相似，梗死相关动脉横截面积减小（0.59±0.57 vs. 1.04±1.26 mm2，p<0.05）。无ST段压低的患者左心室整体功能从第1天到第9天有所改善（4%±11%，p<0.001），而有ST段压低的患者则无改善（0%±7%）。住院期间事件发生率相似；然而，出院后18±11个月的随访显示，有ST段压低的患者死亡和复发性心肌梗死的发生率高于无ST段压低的患者（27% vs. 6%，p = 0.03）。
急性心肌梗死后，约三分之一的患者在动态心电图监测中有ST段压低，与溶栓治疗的使用无关。这些患者观察到的不良预后可能与梗死相关动脉管腔阻塞更严重及左心室功能无改善有关。
