Miranda C P, Lehmann K G, Froelicher V F
Cardiology Department, Long Beach Veterans Affairs Medical Center, CA 90822.
Am Heart J. 1991 Dec;122(6):1617-28. doi: 10.1016/0002-8703(91)90279-q.
Resting ST segment depression has been identified as a marker for adverse cardiac events in patients with and without known coronary artery disease. To correlate this with exercise testing, coronary angiography, and how it impacts on long-term prognosis, a retrospective study was performed on 476 patients, of whom 223 had no clinical or electrocardiographic evidence of prior myocardial infarction while 253 were survivors of an infarction. All patients performed a standard exercise test and underwent diagnostic coronary angiography within an average of 32 days of their exercise test (range 0 to 90 days). Exclusions were women, those with left bundle branch block, left ventricular hypertrophy, use of digoxin, previous revascularization procedures, or significant valvular or congenital heart disease. Long-term follow-up was carried out for an average of 45 months (+/- 17). Of the patients without prior infarction, 23 (10%) had persistent resting ST segment depression, and of those with a prior history of infarction, 37 (15%) also had resting ST segment depression. Patients with resting ST segment depression and no prior myocardial infarction had a higher prevalence of severe coronary disease (three-vessel and/or left main) (30%) than those without resting ST segment depression (16%) (95% confidence interval [CI] for observed difference -5.0% to 33.9%, p = 0.12). The criterion of greater than or equal to 2 mm of additional exercise-induced ST segment depression was a particularly useful marker in these patients for the diagnosis of any coronary disease (likelihood ratio 3.35, 95% CI 0.56 to 19.93, p = 0.06). Patients with resting ST segment depression and a prior myocardial infarction had a 2.5 times higher prevalence of severe coronary artery disease compared with patients without resting ST segment depression (43% versus 17% prevalence, respectively, 95% CI for observed difference 9.38% to 42.8%, p less than 0.001) and also had larger left ventricles postinfarction (left ventricular end-diastolic volume index 102 ml/m2 compared with 96 ml/m2, p less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
静息ST段压低已被确定为有无已知冠状动脉疾病患者发生不良心脏事件的一个标志物。为了将其与运动试验、冠状动脉造影以及它对长期预后的影响相关联，对476例患者进行了一项回顾性研究，其中223例无既往心肌梗死的临床或心电图证据，而253例为心肌梗死幸存者。所有患者均进行了标准运动试验，并在运动试验后平均32天（范围0至90天）内接受了诊断性冠状动脉造影。排除标准为女性、左束支传导阻滞、左心室肥厚、使用地高辛、既往血运重建手术或严重瓣膜或先天性心脏病患者。平均随访45个月（±17个月）。在无既往梗死的患者中，23例（10%）有持续性静息ST段压低，在有既往梗死病史的患者中，37例（15%）也有静息ST段压低。静息ST段压低且无既往心肌梗死的患者严重冠状动脉疾病（三支血管和/或左主干）的患病率（30%）高于无静息ST段压低的患者（16%）（观察到的差异的95%置信区间[CI]为-5.0%至33.9%，p = 0.12）。运动诱发的ST段压低增加≥2 mm这一标准在这些患者中是诊断任何冠状动脉疾病的一个特别有用的标志物（似然比3.35，95%CI 0.56至19.93，p = 0.06）。静息ST段压低且有既往心肌梗死的患者严重冠状动脉疾病的患病率比无静息ST段压低的患者高倍（患病率分别为43%和17%，观察到的差异的95%CI为9.38%至42.8%，p<0.001），并且梗死后期左心室也更大（左心室舒张末期容积指数为102 ml/m2，而无静息ST段压低的患者为96 ml/m2，p<0.001）。（摘要截断于400字）
