Buber Jonathan, Gilutz Harel, Birnbaum Yochai, Friger Michael, Ilia Reuben, Zahger Doron
Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84101, Israel.
Int J Cardiol. 2005 Sep 30;104(2):131-7. doi: 10.1016/j.ijcard.2004.10.020.
ST segment resolution (STR) is a strong predictor of outcome following thrombolysis. If failure of STR could be predicted on admission, better selection of treatment may be possible. Among patients given reperfusion, those with terminal QRS distortion (grade 3 ischemia) have larger infarcts, but the mechanism underlying this association is unclear. Whether grade 3 ischemia on admission can predict STR is unknown.
We studied 180 consecutive patients given thrombolysis for a first anterior acute myocardial infarction (AMI). Multiple variables available on admission were analyzed as predictors of STR at 1, 2, and 24 h and as predictors of the need for rescue percutaneous coronary intervention (PCI).
Multivariate predictors of failure of STR were: for 1 h: extent of ST elevation (OR: 1.09 [1.01-1.18]); for 2 h: no previous use of beta-blockers (OR: 4.71 [1.56-13.98]) and grade 3 ischemia (OR: 6.77 [3.27-13.95]); for 24 h: previous use of aspirin (OR: 6.70 [1.31-34.01]) and grade 3 ischemia (OR: 29.44 [7.30-118.1]). Grade 3 ischemia had a strong positive predictive value for failure of STR at 1 and 2 h and was the strongest predictor of the need for rescue PCI.
Grade 3 ischemia on admission is the strongest independent predictor of failure to achieve myocardial reperfusion after thrombolysis. This association may underlie the larger infarcts associated with grade 3 ischemia. Other predictors of reperfusion failure are the extent of ST segment elevation, prior use of aspirin and no prior use of beta-blockers.
ST段回落（STR）是溶栓治疗后预后的有力预测指标。如果在入院时就能预测STR失败，那么可能会实现更好的治疗选择。在接受再灌注治疗的患者中，出现终末QRS波畸变（3级缺血）的患者梗死面积更大，但这种关联的潜在机制尚不清楚。入院时的3级缺血能否预测STR尚不清楚。
我们研究了180例连续接受首次前壁急性心肌梗死（AMI）溶栓治疗的患者。分析入院时可用的多个变量，作为1小时、2小时和24小时时STR的预测指标以及抢救性经皮冠状动脉介入治疗（PCI）需求的预测指标。
STR失败的多变量预测因素为：1小时时：ST段抬高程度（OR：1.09 [1.01 - 1.18]）；2小时时：既往未使用β受体阻滞剂（OR：4.71 [1.56 - 13.98]）和3级缺血（OR：6.77 [3.27 - 13.95]）；24小时时：既往使用阿司匹林（OR：6.70 [1.31 - 34.01]）和3级缺血（OR：29.44 [7.30 - 118.1]）。3级缺血对1小时和2小时时STR失败具有很强的阳性预测价值，并且是抢救性PCI需求的最强预测指标。
入院时的3级缺血是溶栓后心肌再灌注未成功的最强独立预测因素。这种关联可能是3级缺血相关较大梗死面积的基础。再灌注失败的其他预测因素是ST段抬高程度、既往使用阿司匹林以及既往未使用β受体阻滞剂。
