Terkelsen Christian Juhl, Kaltoft Anne Kjer, Nørgaard Bjarne Linde, Bøttcher Morten, Lassen Jens Flensted, Clausen Karrina, Nielsen Søren Steen, Thuesen Leif, Nielsen Torsten Toftegaard, Bøtker Hans Erik, Andersen Henning Rud
Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark.
J Electrocardiol. 2009 Jan-Feb;42(1):64-72. doi: 10.1016/j.jelectrocard.2008.08.038. Epub 2008 Nov 4.
In patients with ST elevation myocardial infarction (STEMI), spontaneous ST resolution (spontSTR) is a marker of successful microvascular reperfusion. The significance of increase in ST elevation during reperfusion therapy (the ST peak phenomenon), however, is controversial.
The purpose of the study was to evaluate whether preprocedural and periprocedural ST changes predict final infarct size (IS) in STEMI patients treated with primary percutaneous coronary intervention (primary PCI).
Twelve-lead electrocardiograms (ECGs) were acquired in the prehospital phase and on admission in 200 STEMI patients transferred for primary PCI. Continuous ST monitoring was performed during and 90 minutes after primary PCI. The exact timing of interventional procedures and the resulting thrombolysis in myocardial infarction (TIMI) flow were registered. A 1-month single-photon emission computerized tomography was performed to evaluate IS. Patients were stratified into groups according to preprocedural and periprocedural ST changes as follows: patients with spontSTR before primary PCI and without (A) or with (B) ST peak during primary PCI and patients with persistent ST elevation before primary PCI and without (C) or with (D) ST peak during primary PCI.
Groups A (n = 45), B (n = 10), C (n = 109), and D (n = 36) differed with regard to IS (median, 2%, 3%, 13% vs 22% of the left ventricle; P < .0001). In multivariable analysis adjusting for baseline characteristics, preprocedural and periprocedural ECG findings and routine angiography findings, spontSTR was associated with smaller IS (B = -8.6%; P < .001), whereas the ST peak phenomenon was associated with larger IS (B = +5.0%; P = .006). There was no difference in TIMI flow grades in relation to coronary interventions among patients with and without ST peak during primary PCI.
In STEMI patients, spontSTR before primary PCI and the ST peak phenomenon during primary PCI predict minor vs extensive IS independent of angiographic patency grades. Further studies are needed to clarify whether the ST peak phenomenon is "a marker of injury before reperfusion" or "a marker of reperfusion-induced injury."
在ST段抬高型心肌梗死（STEMI）患者中，ST段自发回落（spontSTR）是微血管再灌注成功的一个标志。然而，再灌注治疗期间ST段抬高增加（ST峰现象）的意义存在争议。
本研究的目的是评估在接受直接经皮冠状动脉介入治疗（直接PCI）的STEMI患者中，术前和术中的ST段变化是否能预测最终梗死面积（IS）。
对200例因直接PCI而转诊的STEMI患者在院前阶段和入院时进行12导联心电图（ECG）检查。在直接PCI期间及术后90分钟进行连续ST段监测。记录介入操作的确切时间以及由此产生的心肌梗死溶栓（TIMI）血流情况。进行1个月的单光子发射计算机断层扫描以评估梗死面积。根据术前和术中的ST段变化将患者分为以下几组：直接PCI前有spontSTR且直接PCI期间无（A组）或有（B组）ST峰的患者，以及直接PCI前ST段持续抬高且直接PCI期间无（C组）或有（D组）ST峰的患者。
A组（n = 45）、B组（n = 10）、C组（n = 109）和D组（n = 36）在梗死面积方面存在差异（中位数分别为左心室的2%、3%、13%和22%；P <.0001）。在对基线特征、术前和术中ECG结果以及常规血管造影结果进行校正的多变量分析中，spontSTR与较小的梗死面积相关（B = -8.6%；P <.00），而ST峰现象与较大的梗死面积相关（B = +5.0%；P =.006）。直接PCI期间有或无ST峰的患者在冠状动脉介入治疗相关的TIMI血流分级方面没有差异。
在STEMI患者中，直接PCI前的spontSTR和直接PCI期间的ST峰现象可独立于血管造影通畅分级预测梗死面积较小或较大。需要进一步研究以阐明ST峰现象是“再灌注前损伤的标志”还是“再灌注诱导损伤的标志”。
