Heart Institute, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2011;66(3):437-41. doi: 10.1590/s1807-59322011000300013.
Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory.
This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed.
The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 - 8.53); P = 0.002] in non-STelevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 - 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 - 3.04); P = 0.032].
B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.
与其他部位相比，左心室前壁在 ST 段抬高型心肌梗死中的受累与更差的预后相关。在非 ST 段抬高型心肌梗死中，定位缺血性心肌区域的非侵入性方法受到限制。因此，本报告的目的是确定哪些因素可预测缺血性心肌区域的前壁位置。
本研究纳入了 170 例非 ST 段抬高型心肌梗死患者。分析了临床、超声心动图和实验室特征，包括入院 24 小时内测量的 B 型利钠肽，以及冠状动脉造影特征。
患者平均年龄为 64.5±12.3 岁，112 例患者为男性（66%）。中位随访时间为 23 个月。根据造影结果确定受累区域分为前壁[80 例（47%）]和下壁及侧壁[90 例（53%）]。多变量分析显示，B 型利钠肽是唯一预测非 ST 段抬高型心肌梗死患者前壁梗死的独立因素[比值比（OR）=3.70（95%可信区间：1.61-8.53）；P=0.002]。多变量分析还显示，B 型利钠肽是入院期间心内事件的独立预测因子[OR=5.05（95%可信区间：1.49-17.12）；P=0.009]和随访期间心内事件的独立预测因子[风险比（HR）=1.79（95%可信区间：1.05-3.04）；P=0.032]。
B 型利钠肽是唯一与非 ST 段抬高型心肌梗死前壁受累相关的独立因素，入院时的肽水平可预测院内和随后的心内事件。
