McGehee Jarrett T, Rangasetty Umamahesh C, Atar Shaul, Barbagelata Nestor N, Uretsky Barry F, Birnbaum Yochai
The Division of Cardiology, The Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
J Electrocardiol. 2007 Jan;40(1):26-33. doi: 10.1016/j.jelectrocard.2006.06.001. Epub 2006 Oct 25.
ST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear.
We retrospectively analyzed 155 patients who underwent pPCI and compared grade 2 ischemia (ST elevation without terminal QRS distortion; n = 89) to grade 3 ischemia (n = 66) on admission for baseline characteristics, in-hospital course, and STR immediately after pPCI and at 18 to 24 hours.
Patients with grade 3 ischemia were older (60 +/- 12 vs 56 +/- 11 years; P = .018), had more anterior STEMI (42% vs 17%; P = .0004), and were less often smokers (41% vs 90%; P = .004). The grade 3 ischemic group had significantly less complete STR (35% vs 75% [P < .00001] immediately after pPCI and 33% vs 79% [P < .00001] 18-24 hours after pPCI), a longer hospital stay (6.4 +/- 4.1 vs 4.9 +/- 1.9 days; P = .008), and higher peak CKMB (292 +/- 231 vs 195 +/- 176 ng/mL; P = .0005). Duration of symptoms before pPCI (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.724-0.969; P = .017) and grade 3 ischemia (OR, 0.181; 95% CI, 0.068-0.480; P < .001) were negative predictors of complete STR, whereas nonanterior STEMI (OR, 5.95; 95% CI, 2.154-16.436; P < .001) and initial sum of ST elevation (OR, 3.132; 95% CI, 1.140-8.605; P = .027) were positive predictors.
Grade 3 ischemia on presentation of STEMI and duration of chest pain are strong independent predictors of failure to achieve complete STR after pPCI.
ST段回落（STR）是心肌组织再灌注的替代标志物，也是ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（pPCI）后预后的预测指标。终末QRS波畸变（3级缺血）已被证明可预测STEMI溶栓治疗后STR失败，但3级缺血对pPCI后STR的预测能力尚不清楚。
我们回顾性分析了155例行pPCI的患者，并比较了入院时2级缺血（ST段抬高但无终末QRS波畸变；n = 89）与3级缺血（n = 66）患者的基线特征、住院过程以及pPCI后即刻和18至24小时的STR情况。
3级缺血患者年龄更大（60±12岁 vs 56±11岁；P = 0.018），前壁STEMI更多（42% vs 17%；P = 0.0004），吸烟者更少（41% vs 90%；P = 0.004）。3级缺血组完全STR明显更少（pPCI后即刻为35% vs 75% [P < 0.00001]，pPCI后18 - 24小时为33% vs 79% [P < 0.00001]），住院时间更长（6.4±4.1天 vs 4.9±1.9天；P = 0.008），CKMB峰值更高（292±231 vs 195±176 ng/mL；P = 0.0005）。pPCI前症状持续时间（比值比[OR]，0.838；95%置信区间[CI]，0.724 - 0.969；P = 0.017）和3级缺血（OR，0.181；95% CI，0.068 - 0.480；P < 0.001）是完全STR的负性预测指标，而非前壁STEMI（OR，5.95；95% CI，2.154 - 16.436；P < 0.001）和初始ST段抬高总和（OR，3.132；95% CI，1.140 - 8.605；P = 0.027）是正性预测指标。
STEMI发病时的3级缺血和胸痛持续时间是pPCI后未能实现完全STR的强有力独立预测指标。
