Mieszczanska Hanna, Pietrasik Grzegorz, Piotrowicz Katarzyna, McNitt Scott, Moss Arthur J, Zareba Wojciech
Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, Rochester, New York, USA.
Am J Cardiol. 2008 Jan 1;101(1):20-4. doi: 10.1016/j.amjcard.2007.07.077.
There are limited data regarding gender-related differences in electrocardiographic (ECG) presentation in patients after myocardial infarction (MI) and the prognostic value of ECG variables in women. A series of ECG parameters were analyzed in 838 patients (216 women, 622 men) using standard electrocardiography performed 5 to 7 days after first MI, and their associations with gender and risk for cardiac events, defined as cardiac death, nonfatal MI, or unstable angina, were evaluated. Heart rate was faster and QTc duration was longer, whereas QRS duration was shorter in women compared with men. Women had more lateral ST depressions and more T-wave inversions in the anterior and lateral regions. During mean 2-year follow-up, there were 138 events in men and 65 in women; women had a 38% greater risk for recurrent events (adjusted hazard ratio [HR] 1.38, p = 0.031). In multivariate Cox regression analysis, ST-segment elevation in leads V(1) to V(4) on the fifth to seventh day after MI was associated with increased risk for recurrent events in women (adjusted HR 2.16, p = 0.003) but not in men (adjusted HR = 0.81, p = 0.32). ST depressions in leads V(5), V(6), I, or aVL (adjusted HR 1.70, p = 0.006) in men but not in women (adjusted HR 0.98, p = 0.93) were identified as a risk factor for recurrent events. In conclusion, there are gender-related differences in ECG presentation and the prognostic significance of ECG findings after MI. ST-segment elevation in anterior leads is a significant predictor of events in women, whereas ST depression in lateral leads is a significant predictor in men.
关于心肌梗死（MI）后患者心电图（ECG）表现的性别差异以及女性心电图变量的预后价值，相关数据有限。对838例患者（216例女性，622例男性）进行了一系列心电图参数分析，这些患者在首次心肌梗死后5至7天接受了标准心电图检查，并评估了这些参数与性别以及心脏事件风险（定义为心源性死亡、非致死性心肌梗死或不稳定型心绞痛）之间的关联。与男性相比，女性的心率更快，QTc间期更长，而QRS间期更短。女性在前侧壁导联有更多的ST段压低以及前壁和侧壁导联有更多的T波倒置。在平均2年的随访期间，男性发生138起事件，女性发生65起事件；女性复发事件的风险高38%（校正风险比[HR] 1.38，p = 0.031）。在多变量Cox回归分析中，心肌梗死后第5至7天V（1）至V（4）导联的ST段抬高与女性复发事件风险增加相关（校正HR 2.16，p = 0.003），而与男性无关（校正HR = 0.81，p = 0.32）。男性V（5）、V（6）、I或aVL导联的ST段压低（校正HR 1.70，p = 0.006）被确定为复发事件的危险因素，而女性则不然（校正HR 0.98，p = 0.93）。总之，心肌梗死后心电图表现存在性别差异，且心电图结果的预后意义也有所不同。前壁导联的ST段抬高是女性事件的重要预测指标，而侧壁导联的ST段压低是男性事件的重要预测指标。
