Department of Medicine, University of Alberta, Edmonton, Canada.
Eur Heart J. 2010 Mar;31(5):573-81. doi: 10.1093/eurheartj/ehp494. Epub 2009 Dec 1.
To evaluate the prognostic impact of ST depression resolution among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial.
In this study, 4729 of 5745 patients had analysable ECGs demonstrating concomitant ST-segment depression. Resolution of summation operatorST elevation (STE-R) and summation operatorST depression (STD-R) on 30 min post-PCI ECGs was dichotomized into those with > or =50 vs. <50% ST-segment resolution. Overall, 1143 patients (24%) had STD-R<50%. These patients had higher risk characteristics including older age, female sex, diabetes, hypertension, prior CHF/MI, Killip class >I, triple vessel disease, and less frequent TIMI 3 flow in the culprit coronary vessel post-PCI. After multivariable adjustment and accounting for STE-R, STD-R<50% remained an independent predictor for 90 day death and the composite of death, cardiogenic shock, or CHF. When compared with patients with both STE-R and STD-R> or =50%, patients with both STE-R and STD-R<50% had the worst outcomes [hazard ratios (HR) 90 day death: 2.54; 95% confidence intervals (CI): 1.71-3.77; HR 90 day composite: 2.18; 95% CI: 1.63-2.91].
When ST depression is present in STEMI patients undergoing primary PCI, STD-R<50% provides independent prognostic value that is incremental to STE-R.
评估在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，ST 段压低消退的预后影响，该研究为评估 Pexelizumab 在急性心肌梗死中的作用（APEX-AMI）试验。
在这项研究中，5745 例患者中有 4729 例可分析心电图，显示并发 ST 段压低。PCI 后 30 分钟心电图上的总和算子 ST 段抬高（STE-R）和总和算子 ST 段压低（STD-R）的消退被分为>或=50%与<50% ST 段消退。总体而言，1143 例患者（24%）有 STD-R<50%。这些患者具有更高的风险特征，包括年龄较大、女性、糖尿病、高血压、既往心力衰竭/心肌梗死、Killip 分级>I、三支血管病变以及 PCI 后罪犯血管中 TIMI 3 级血流较少。在多变量调整后，考虑到 STE-R，STD-R<50%仍然是 90 天死亡和死亡、心源性休克或心力衰竭复合终点的独立预测因素。与 STE-R 和 STD-R>或=50%的患者相比，STE-R 和 STD-R 均<50%的患者的预后最差[90 天死亡的危险比（HR）：2.54；95%置信区间（CI）：1.71-3.77；90 天复合终点的 HR：2.18；95%CI：1.63-2.91]。
在接受直接 PCI 的 STEMI 患者中，如果存在 ST 段压低，STD-R<50%提供了与 STE-R 相比具有独立预后价值的信息。
