Phibbs Brendan, Nelson William
Ann Noninvasive Electrocardiol. 2010 Jul;15(3):191-9. doi: 10.1111/j.1542-474X.2010.00377.x.
The distinction between ST elevation and nonST elevation infarcts is widely accepted and is employed as a guide to management.
This is review of the world literature to assess the basis for this distinction, since the two studies on which it is based are seriously flawed in method and conclusions.
Pathologic and clinical studies were reviewed from the world literature.
The pathology of the two subsets is identical as are the morbidity, mortality and clinical course. Non-ST elevation infarcts are likely to be subsequent, to occur in older patients and to involve the circumflex artery: this subset therefore includes a high-risk group. ST deviation in any part of the electric field of the heart will predictably be accompanied by reciprocal deviation if the entire field of the heart is mapped. Further, ST deviation of infarction is often transient, resolving in minutes so that infarcts will be predictably misclassified. ST deviation per se is therefore not a rational basis for classification of infarcts. In fact, invasive therapy is indicated in both subsets with identical results.
The distinction between ST elevation and non-ST elevation infarcts is baseless. The high risk subgroup included in the non-ST elevation infarct set should not be denied the benefit of early invasive therapy.
ST段抬高型梗死与非ST段抬高型梗死之间的区别已被广泛接受，并被用作管理指南。
鉴于该区别所基于的两项研究在方法和结论上存在严重缺陷，本文对世界文献进行综述，以评估这种区别的依据。
对世界文献中的病理和临床研究进行综述。
这两个亚组的病理学相同，发病率、死亡率和临床病程也相同。非ST段抬高型梗死可能是后续发生的，多见于老年患者，且累及回旋支动脉：因此该亚组包括一个高危组。如果对心脏的整个电场进行标测，心脏电场任何部位的ST段偏移可预见地会伴有对应性偏移。此外，梗死的ST段偏移通常是短暂的，几分钟内即可消失，因此梗死很可能被错误分类。因此，ST段偏移本身并不是梗死分类的合理依据。事实上，两个亚组均需进行有创治疗，且结果相同。
ST段抬高型梗死与非ST段抬高型梗死之间的区别毫无根据。不应剥夺非ST段抬高型梗死组中高危亚组接受早期有创治疗的益处。
