Atak Ramazan, Ileri Mehmet, Senen Kubilay, Turhan Hasan, Erbay Ali Riza, Basar Nurcan, Yetkin Ertan, Demirkan Deniz
Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Heart Vessels. 2004 Mar;19(2):63-7. doi: 10.1007/s00380-003-0740-x.
The aim of this study was to investigate the correlation between the ST-segment and T-wave patterns in predischarge electrocardiogram and patency of left anterior descending coronary artery in patients with a first anterior myocardial infarction (AMI). One hundred and fifty-six of 175 consecutive patients who were admitted to our clinic between January 2000 and September 2002 due to a first episode of transmural AMI and who received thrombolytic therapy were enrolled. Coronary angiography was performed by the Judkins method on the 6th-10th day after the acute infarction. The corrected TIMI frame count (CTFC) was estimated according to the previously described method. According to the combination of the ST-segment and T-wave morphology on the day (6-10) of cardiac catheterization, patients were classified into four groups: group A, ST elevation <<0.1 mV and negative T waves; group B, ST elevation >or=0.1 mV and negative T waves; group C, ST elevation <<0.1 mV and positive T waves; and group D, ST elevation >or=0.1 mV and positive T waves. Of the 99 patients with negative T waves, 47 (48%) had CTFC <or=27, 32 (32%) CTFC between 27 and 40, 15 (15%) CTFC >or=40-100, and 5 (5%) CTFC >>100. Of the 57 patients with positive T waves, CTFC was <or=27 in 14 (25%), between 27 and 40 in 17 (30%), >or=40-100 in 11 (19%), and >>100 in 15 (26%) ( P << 0.001). From the 76 patients with an isoelectric ST segment, 38 (50%) had CTFC <or=27, 29 (38%) CTFC between 27 and 40, 8 (11%) CTFC >or=40-100, and 1 (1%) CTFC >>100. Of the 80 patients with an elevated ST segment, 23 (29%) had CTFC <or=27, 20 (25%) CTFC between 27 and 40, 18 (23%) CTFC >or=40-100, and 19 (23%) CTFC >>100 ( P << 0.001). Use of the combination of two electrocardiographic parameters (ST segment and T waves) also indicated that there were significant differences between groups A and D, and groups B and D ( P << 0.001 and P << 0.05, respectively). Development of an isoelectric ST segment with negative T waves may indicate a better degree of reperfusion after AMI. In contrast, patients in whom ST-segment elevation and positive T waves remain at discharge from the coronary care unit have a higher probability of a nonpatent left anterior descending artery.
本研究旨在探讨首次前壁心肌梗死（AMI）患者出院前心电图ST段和T波形态与左前降支冠状动脉通畅情况之间的相关性。选取2000年1月至2002年9月因首次透壁性AMI入院并接受溶栓治疗的175例连续患者中的156例。急性心肌梗死后第6 - 10天采用Judkins法进行冠状动脉造影。根据先前描述的方法估算校正的心肌梗死溶栓分级帧数（CTFC）。根据心导管检查当天（6 - 10天）ST段和T波形态的组合，将患者分为四组：A组，ST段抬高<<0.1 mV且T波倒置；B组，ST段抬高≥0.1 mV且T波倒置；C组，ST段抬高<<0.1 mV且T波直立；D组，ST段抬高≥0.1 mV且T波直立。在99例T波倒置的患者中，47例（48%）CTFC≤27，32例（32%）CTFC在27至40之间，15例（15%）CTFC≥40 - 100，5例（5%）CTFC>>100。在57例T波直立的患者中，14例（25%）CTFC≤27，17例（30%）CTFC在27至40之间；11例（19%）CTFC≥40 - 100，15例（26%）CTFC>>100（P<<0.001）。在76例ST段等电位的患者中，38例（50%）CTFC≤27，29例（38%）CTFC在27至40之间，8例（11%）CTFC≥40 - 100，1例（1%）CTFC>>100。在80例ST段抬高的患者中，23例（29%）CTFC≤27，20例（25%）CTFC在27至40之间，18例（23%）CTFC≥40 - 100，19例（23%）CTFC>>100（P<<0.001）。使用两个心电图参数（ST段和T波）的组合也表明，A组与D组、B组与D组之间存在显著差异（分别为P<<0.001和P<<0.05）。ST段等电位且T波倒置可能表明AMI后再灌注程度较好。相反，冠心病监护病房出院时ST段抬高且T波直立的患者左前降支动脉未通畅的可能性更高。
