无既往Q波心肌梗死患者的应激性ST段抬高
Stress-induced ST-segment elevation in patients without prior Q-wave myocardial infarction.
作者信息
Beinart Roy, Matetzky Shlomi, Shechter Michael, Fefer Paul, Rozen Eli, Beinart Tal, Hod Hanoch, Chouraqui Pierre
机构信息
Heart Institute, Chaim Sheba Medical Center, 52 621 Tel HaShomer, Israel.
出版信息
J Electrocardiol. 2008 Jul-Aug;41(4):312-7. doi: 10.1016/j.jelectrocard.2007.12.005. Epub 2008 May 19.
BACKGROUND
Stress-induced ST-segment elevation is an uncommon finding that usually occurs in patients with prior myocardial infarction (MI). Our purpose was to assess the angiographic and clinical significance of this finding in patients without prior MI.
METHODS
Of the 29002 consecutive ambulatory patients who underwent stress myocardial perfusion imaging over a 5-year period, 205 (0.7%) developed stress-induced ST-segment elevation, of whom 39 (19%) had no Q-wave MI in leads showing ST-segment elevation during either exercise (n = 31) or dipyridamole (n = 8) stress myocardial perfusion imaging. All 39 patients were hospitalized and underwent coronary angiography.
RESULTS
Significant coronary artery disease was found in all 39 patients: 87% had critical (>or=90%) stenosis, and 59% had multiple vessel disease. During hospitalization, 37 patients (95%) underwent revascularization.
CONCLUSIONS
In patients without prior Q-wave MI, stress-induced ST-segment elevation is associated with critical coronary artery disease. Therefore, these patients should be considered for early coronary investigation.
背景
应激诱导的ST段抬高是一种不常见的表现，通常发生在既往有心肌梗死（MI）的患者中。我们的目的是评估这一表现在无既往MI患者中的血管造影及临床意义。
方法
在5年期间接受应激心肌灌注成像的29002例连续门诊患者中，205例（0.7%）出现应激诱导的ST段抬高，其中39例（19%）在运动（n = 31）或双嘧达莫（n = 8）应激心肌灌注成像期间，显示ST段抬高的导联中无Q波MI。所有39例患者均住院并接受冠状动脉造影。
结果
所有39例患者均发现有严重冠状动脉疾病：87%有严重（≥90%）狭窄，59%有多支血管病变。住院期间，37例患者（95%）接受了血运重建。
结论
在无既往Q波MI的患者中，应激诱导的ST段抬高与严重冠状动脉疾病相关。因此，这些患者应考虑早期进行冠状动脉检查。
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