Windhausen Fons, Hirsch Alexander, Tijssen Jan G P, Cornel Jan Hein, Verheugt Freek W A, Klees Margriet I, de Winter Robbert J
Department of Cardiology of the Academic Medical Center, Amsterdam, The Netherlands.
J Electrocardiol. 2007 Sep-Oct;40(5):408-15. doi: 10.1016/j.jelectrocard.2007.05.008. Epub 2007 Jul 2.
We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive treatment strategy.
A 12-lead ECG obtained at admission was available for analysis from 1163 patients. The presence and magnitude of ST-segment deviation was measured in each lead, and absolute ST-segment deviation was summed. The effect of treatment strategy was assessed for patients with or without SigmaST-segment deviation of at least 1 mm.
The incidence of death or myocardial infarction (MI) by 1 year in patients with SigmaST-segment deviation of at least 1 mm was 18.0% compared with 11.1% in patients with SigmaST-segment deviation of less than 1 mm (P = .001). Among patients with SigmaST-segment deviation of at least 1 mm, the incidence of death or MI was 21.9% in the early invasive group compared with 14.2% in SI group (P < .01). However, we observed a significantly higher rate of MI after hospital discharge among patients with SigmaST-segment deviation of at least 1 mm randomized to SI who did not undergo angiography compared with patients who underwent angiography before discharge (10.9% vs 2.4%, P = .003). In a forward logistic regression analysis, the presence of ST-segment deviation was an independent predictor for failure of medical therapy (coronary angiography within 30 days after randomization in the SI group) (odds ratio, 1.56; 95% confidence interval, 1.12-2.18; P = .009).
Patients with non-ST-elevation acute coronary syndrome and an elevated troponin T and SigmaST-segment deviation of at least 1 mm are at increased risk of death or MI, more often fail on medical therapy, and more often experience a spontaneous MI after discharge when angiography was not performed during initial hospitalization.
我们评估了非ST段抬高型急性冠状动脉综合征且肌钙蛋白T升高的患者，随机接受选择性侵入性（SI）或早期侵入性治疗策略时，入院心电图（ECG）上累积（总和）ST段偏移的预后意义。
1163例患者入院时获得的12导联心电图可用于分析。测量每个导联ST段偏移的存在和幅度，并计算绝对ST段偏移的总和。对总和ST段偏移至少1mm的患者和未达到此标准的患者评估治疗策略的效果。
总和ST段偏移至少1mm的患者1年内死亡或心肌梗死（MI）的发生率为18.0%，而总和ST段偏移小于1mm的患者为11.1%（P = 0.001）。在总和ST段偏移至少1mm的患者中，早期侵入性治疗组死亡或MI的发生率为21.9%，而SI组为14.2%（P < 0.01）。然而，我们观察到，随机接受SI治疗且未进行血管造影的总和ST段偏移至少1mm的患者出院后MI发生率显著高于出院前接受血管造影的患者（10.9%对2.4%，P = 0.003）。在前瞻性逻辑回归分析中，ST段偏移的存在是药物治疗失败（SI组随机分组后30天内进行冠状动脉造影）的独立预测因素（比值比，1.56；95%置信区间，1.12 - 2.18；P = 0.009）。
非ST段抬高型急性冠状动脉综合征、肌钙蛋白T升高且总和ST段偏移至少1mm的患者死亡或MI风险增加，药物治疗更常失败，且初始住院期间未进行血管造影时出院后更常发生自发性MI。
