Kaul P, Newby L K, Fu Y, Mark D B, Goodman S G, Wagner G S, Harrington R A, Granger C B, Van de Werf F, Ohman E M, Armstrong P W
University of Alberta, Edmonton, Alberta, Canada.
Heart. 2005 Jul;91(7):876-81. doi: 10.1136/hrt.2004.042887.
To examine the interaction between ST segment depression on the baseline ECG and subsequent in-hospital revascularisation on six month mortality among patients with non-ST elevation acute coronary syndromes. To examine whether ST segment depression influenced clinical decision making and whether there was international variation in the use of cardiac procedures across ST segment depression categories.
11 453 patients enrolled in GUSTO-IIB (global use of strategies to open occluded coronary arteries), PARAGON (platelet IIb/IIIa antagonism for the reduction of acute coronary syndrome events in a global organisation network) -A, and PARAGON-B were studied. Patients were categorised as having no ST segment depression, 1 mm ST segment depression in two contiguous leads, and ST segment depression > or = 2 mm in two contiguous leads. International practice across four geographic regions was examined: USA, Canada, Europe, and Australia/New Zealand.
Revascularisation appeared to have no impact on survival among patients with no ST segment depression; however, revascularisation was associated with a significant survival benefit among patients with ST segment depression > or = 1 mm. There was an inverse relation between the extent of ST segment depression and the use of angiography as well as angioplasty (p < 0.01). However, patients with ST segment depression > or = 2 mm were more likely to undergo bypass surgery. The only significant trend of increasing use of revascularisation procedures with increasing ST segment depression was observed in the USA.
International practice patterns in procedure use appear to be insensitive to the extent of ST segment depression. Major opportunities for more efficient delivery of care exist in all regions.
研究非ST段抬高型急性冠状动脉综合征患者基线心电图ST段压低与随后住院期间血运重建对6个月死亡率的相互作用。研究ST段压低是否影响临床决策，以及不同ST段压低类别中心脏手术的使用是否存在国际差异。
对参加GUSTO-IIB（全球开放闭塞冠状动脉策略的应用）、PARAGON（全球组织网络中血小板IIb/IIIa拮抗剂减少急性冠状动脉综合征事件）-A和PARAGON-B研究的11453例患者进行研究。患者被分为无ST段压低、两个相邻导联ST段压低1mm以及两个相邻导联ST段压低≥2mm。研究了四个地理区域（美国、加拿大、欧洲和澳大利亚/新西兰）的国际实践情况。
血运重建似乎对无ST段压低的患者生存没有影响；然而，血运重建与ST段压低≥1mm的患者显著的生存获益相关。ST段压低程度与血管造影及血管成形术的使用呈负相关（p<0.01）。然而，ST段压低≥2mm的患者更有可能接受搭桥手术。仅在美国观察到随着ST段压低程度增加血运重建手术使用增加的显著趋势。
手术使用的国际实践模式似乎对ST段压低程度不敏感。所有地区都存在更有效提供医疗服务的主要机会。
