McLaughlin Michael G, Stone Gregg W, Aymong Eve, Gardner Graham, Mehran Roxana, Lansky Alexandra J, Grines Cindy L, Tcheng James E, Cox David A, Stuckey Thomas, Garcia Eulogio, Guagliumi Giulio, Turco Mark, Josephson Mark E, Zimetbaum Peter
Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Am Coll Cardiol. 2004 Sep 15;44(6):1215-23. doi: 10.1016/j.jacc.2004.06.053.
This study was done to assess and compare the prognostic significance of multiple methods for measuring ST-segment elevation resolution (STR) following primary percutaneous coronary intervention (PCI).
Resolution of ST-segment elevation (STE) is a powerful predictor of both infarct-related artery patency and mortality in acute myocardial infarction (AMI). Recent thrombolytic studies have suggested that simple measures of STR may be as powerful as more complex algorithms. The optimal method of assessing STR following primary PCI has not been studied.
We analyzed 700 patients with technically adequate baseline and post-PCI electrocardiograms from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Five methods were used to assess STR: 1) summed %STR across multiple leads (SigmaSTR); 2) %STR in the single lead with maximum baseline STE (MaxSTR); 3) absolute maximum STE before the procedure; 4) absolute maximum STE after intervention (MaxSTPost); and 5) a categorical variable based upon MaxSTPost (High Risk).
At 30 days, SigmaSTR, MaxSTR, and MaxSTPost all correlated strongly with mortality (p = 0.004, p = 0.005, and p < 0.0001, respectively) and the combined end point of mortality or reinfarction (p = 0.001, p = 0.001, and p < 0.0001). At one year, SigmaSTR and MaxSTPost correlated with mortality (p = 0.04, p = 0.0001), reinfarction (p = 0.02, p = 0.0015), and the combined end point (p = 0.02, p < 0.0001). By multivariate analysis, only the simpler measures of MaxSTPost and High Risk categorization independently predicted all outcomes at both time points.
The STR following primary PCI in AMI correlates strongly with mortality and reinfarction, independent of target vessel patency. The simple measure of the maximal residual degree of STE after primary PCI is a strong independent predictor of both survival and freedom from reinfarction at 30 days and 1 year.
本研究旨在评估和比较多种测量直接经皮冠状动脉介入治疗（PCI）后ST段抬高消退（STR）方法的预后意义。
ST段抬高（STE）的消退是急性心肌梗死（AMI）中梗死相关动脉通畅和死亡率的有力预测指标。近期溶栓研究表明，简单的STR测量方法可能与更复杂的算法一样有效。直接PCI后评估STR的最佳方法尚未得到研究。
我们分析了来自控制阿昔单抗和器械研究以降低晚期血管成形术并发症（CADILLAC）试验的700例基线和PCI后心电图技术上合格的患者。采用五种方法评估STR：1）多个导联的STR总和百分比（SigmaSTR）；2）基线STE最大的单个导联中的STR百分比（MaxSTR）；3）术前绝对最大STE；4）干预后绝对最大STE（MaxSTPost）；5）基于MaxSTPost的分类变量（高风险）。
在30天时，SigmaSTR、MaxSTR和MaxSTPost均与死亡率（分别为p = 0.004、p = 0.005和p < 0.0001）以及死亡率或再梗死的联合终点（p = 0.001、p = 0.001和p < 0.0001）密切相关。在1年时，SigmaSTR和MaxSTPost与死亡率（p = 0.04、p = 0.0001）、再梗死（p = 0.02、p = 0.0015）以及联合终点（p = 0.02、p < 0.0001）相关。通过多变量分析，仅更简单的MaxSTPost测量方法和高风险分类在两个时间点均能独立预测所有结局。
AMI患者直接PCI后的STR与死亡率和再梗死密切相关，与靶血管通畅情况无关。直接PCI后STE最大残留程度的简单测量方法是30天和1年时生存和无再梗死的有力独立预测指标。
