AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, 8001 Zürich, Switzerland.
Swiss Med Wkly. 2010 Aug 24;140:w13078. doi: 10.4414/smw.2010.13078. eCollection 2010.
Diagnosis of acute myocardial infarction (AMI) rests upon clinical, electrocardiographic and biochemical parameters. Previous studies reported AMI patients who present with non-specific ECGs.
To examine clinical or demographic features of AMI patients presenting with or without ECG changes and assess the impact of these ECGs on treatment and outcome.
Using the AMIS Plus data, patients admitted between 2003 and 2008 with a definite diagnosis of AMI (clinical symptoms, elevated troponin levels) were stratified according to the admission ECG into group 1 with normal/non-specific ECGs and group 2 with ECG changes.
Of 14 957 patients, 1085 (7.3%) belonged to group 1 and 13 872 (92.7%) to group 2. There were no differences between the two groups in age (65.9 yr vs. 65.4 yr), gender (28% female), diabetes (19% vs. 18%), hypertension (61% vs. 59%), family history (35% vs. 33%) or smoking (37% vs. 38%). Dyslipidaemia (62% vs. 56%; p <0.001), history of CAD (39% vs. 35%; p = 0.023) and obesity (BMI >30 kg/m2 [23% vs. 19%; p = 0.003]) were more frequent in group 1 who were admitted longer after symptom onset (280 min vs. 230 min). Patients in group 1 were exposed to less intensive pharmacological and interventional treatments (aspirin [93.6% vs. 95.3%; p = 0.012], clopidogrel [70% vs. 73%; p = 0.046], unfractionated heparin [59% vs. 65%; p <0.001], ACE inhibitors or angiotensin II antagonists [46% vs. 53%; p <0.001]). However, therapy with beta-blockers (72% vs. 70%), statins (75% vs. 76%) and nitrates (59% vs. 57%) did not differ between groups. Patients in group 1 underwent PCI significantly less frequently (69% vs. 77%) with a longer hospital delay (589 min vs. 96 min). No differences were found for reinfarction (both 1.4%) and a cerebrovascular event (0.4% vs. 0.8%). Cardiogenic shock (5% vs. 2%; p <0.001) and mortality during hospitalisation were higher in group 2 (6% vs. 3%; p <0.001). A normal/non-specific ECG on admission was not an independent predictor of in-hospital mortality (OR 0.61; 95% CI 0.34-1.11; p = 0.104).
Despite less intensive treatment, AMI patients who presented with a normal/non-specific ECG developed cardiogenic shock less frequently during their hospitalisation and had a lower crude mortality rate compared to those with ECG changes on admission. Nevertheless, reinfarctions and cerebrovascular events occurred evenly in all AMI patients, regardless of their admission ECG.
急性心肌梗死（AMI）的诊断依赖于临床、心电图和生化参数。先前的研究报告了表现为非特异性心电图的 AMI 患者。
检查出现心电图改变和无心电图改变的 AMI 患者的临床或人口统计学特征，并评估这些心电图对治疗和预后的影响。
使用 AMIS Plus 数据，根据入院时的心电图将 2003 年至 2008 年间明确诊断为 AMI（临床症状、肌钙蛋白水平升高）的患者分为两组：第 1 组心电图正常/非特异性，第 2 组心电图有改变。
在 14957 例患者中，1085 例（7.3%）属于第 1 组，13872 例（92.7%）属于第 2 组。两组在年龄（65.9 岁 vs. 65.4 岁）、性别（28%女性）、糖尿病（19% vs. 18%）、高血压（61% vs. 59%）、家族史（35% vs. 33%）或吸烟（37% vs. 38%）方面无差异。第 1 组血脂异常（62% vs. 56%；p<0.001）、冠心病史（39% vs. 35%；p=0.023）和肥胖（BMI>30 kg/m2[23% vs. 19%；p=0.003]）更为常见，且症状发作后入院时间更长（280 分钟 vs. 230 分钟）。第 1 组患者接受的药物和介入治疗强度较低（阿司匹林[93.6% vs. 95.3%；p=0.012]、氯吡格雷[70% vs. 73%；p=0.046]、未分级肝素[59% vs. 65%；p<0.001]、ACE 抑制剂或血管紧张素 II 拮抗剂[46% vs. 53%；p<0.001]）。然而，β受体阻滞剂（72% vs. 70%）、他汀类药物（75% vs. 76%）和硝酸盐（59% vs. 57%）的使用率两组间无差异。第 1 组患者接受经皮冠状动脉介入治疗的频率明显较低（69% vs. 77%），住院时间延迟更长（589 分钟 vs. 96 分钟）。两组再梗死（均为 1.4%）和脑血管事件（0.4% vs. 0.8%）发生率无差异。第 2 组心源性休克（5% vs. 2%；p<0.001）和住院期间死亡率（6% vs. 3%；p<0.001）更高。入院时心电图正常/非特异性并非住院期间死亡率的独立预测因素（OR 0.61；95%CI 0.34-1.11；p=0.104）。
尽管治疗强度较低，但与入院时心电图有改变的患者相比，出现心电图正常/非特异性的 AMI 患者在住院期间发生心源性休克的频率较低，且死亡率较低。然而，所有 AMI 患者的再梗死和脑血管事件发生率相当，与入院时的心电图无关。
