Vatterott P J, Hammill S C, Bailey K R, Wiltgen C M, Gersh B J
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1991 Feb;17(2):330-7. doi: 10.1016/s0735-1097(10)80095-6.
This study evaluated the relation between patency of the infarct-related artery and the presence of late potentials on the signal-averaged electrocardiogram (ECG) in 124 consecutive patients (98 men, 26 women; mean age 59 years) with acute myocardial infarction receiving thrombolytic therapy, acute percutaneous transluminal coronary angioplasty or standard care. All patients were studied by coronary angiography, measurement of ejection fraction and signal-averaged ECG. The infarct-related artery was closed in 51 patients and open in 73. Among patients with no prior myocardial infarction undergoing early attempted reperfusion therapy, a patent artery was associated with a decreased incidence of late potentials (20% versus 71%; no significant difference in ejection fraction). In the 48 patients receiving thrombolytic agents within 4 h of symptom onset, the incidence of late potentials was 24% and 83% among patients with an open or closed artery, respectively (p less than 0.04). The most powerful predictors of late potentials were the presence of a closed infarct-related artery, followed by prior infarction and patient age. Among patients receiving thrombolytic agents within 4 h of symptom onset, the only variable that was predictive of the presence of late potentials was a closed infarct-related artery. These data imply that reperfusion of an infarct-related artery has a beneficial effect on the electrophysiologic substrate for serious ventricular arrhythmias that is independent of change in left ventricular ejection fraction as an index of infarct size. These findings might explain, in part, the low late mortality rate in survivors of myocardial infarction with documented reperfusion of the infarct-related artery.
本研究评估了124例接受溶栓治疗、急性经皮腔内冠状动脉成形术或标准治疗的急性心肌梗死连续患者（98例男性，26例女性；平均年龄59岁）梗死相关动脉通畅情况与信号平均心电图（ECG）上晚电位存在之间的关系。所有患者均接受冠状动脉造影、射血分数测量和信号平均心电图检查。51例患者梗死相关动脉闭塞，73例通畅。在未发生过心肌梗死且接受早期再灌注治疗的患者中，动脉通畅与晚电位发生率降低相关（20%对71%；射血分数无显著差异）。在症状发作后4小时内接受溶栓药物治疗的48例患者中，动脉通畅或闭塞的患者晚电位发生率分别为24%和83%（p<0.04）。晚电位最有力的预测因素是梗死相关动脉闭塞，其次是既往梗死和患者年龄。在症状发作后4小时内接受溶栓药物治疗的患者中，唯一能预测晚电位存在的变量是梗死相关动脉闭塞。这些数据表明，梗死相关动脉再灌注对严重室性心律失常的电生理基质具有有益作用，这与作为梗死面积指标的左心室射血分数变化无关。这些发现可能部分解释了梗死相关动脉有记录再灌注的心肌梗死幸存者中较低的晚期死亡率。
