Huang Henry D, Birnbaum Yochai
The Section of Cardiology, Baylor College of Medicine, Houston, TX77030, USA.
J Electrocardiol. 2011 Sep-Oct;44(5):494.e1-494.e12. doi: 10.1016/j.jelectrocard.2011.06.002.
It is well accepted that early reperfusion is beneficial in patients with acute myocardial infarction presenting with ST elevation (STE). Earlier studies suggested lack of beneficial effects in patients presenting without STE and even with ST depression. Currently, time to reperfusion is considered to be a quality of care measure, and the latest American College of Cardiology/American Heart Association guidelines for the treatment of STE acute myocardial infarction (STEMI) emphasize that the physician at the emergency department should make reperfusion decisions within 10 minutes of performing the initial electrocardiogram (ECG). However, not all ECGs with STE necessarily reflect transmural infarction from acute thrombotic occlusion of an epicardial coronary artery, as a large number of patients presenting with compatible symptoms have baseline STE. In some cases a pattern of benign nonischemic STE (NISTE) can be recognized fairly easily. Other times, differentiating between true STEMI and NISTE may be difficult. It should be remembered that patients presenting with chest pain and showing benign pattern of NISTE (eg, "early repolarization" or STE secondary to left ventricular hypertrophy) may have true ischemic pain and non-STE myocardial infarction or even STEMI on top of the baseline benign pattern. It seems that, in the "real world," the ability of physicians to differentiate NISTE from STEMI based on the presenting ECG pattern widely varies and depends on the prevalence of baseline NISTE in the patient population. Further studies are needed to assess the ability of various ECG criteria to accurately differentiate between STEMI and NISTE.
人们普遍认为，早期再灌注对出现ST段抬高（STE）的急性心肌梗死患者有益。早期研究表明，对于未出现STE甚至ST段压低的患者，再灌注并无益处。目前，再灌注时间被视为一项医疗质量指标，美国心脏病学会/美国心脏协会最新的ST段抬高型急性心肌梗死（STEMI）治疗指南强调，急诊科医生应在完成初始心电图（ECG）检查后的10分钟内做出再灌注决策。然而，并非所有出现STE的ECG都必然反映出由于心外膜冠状动脉急性血栓闭塞导致的透壁梗死，因为大量出现相关症状的患者存在基线STE。在某些情况下，良性非缺血性STE（NISTE）模式相当容易识别。但在其他时候，区分真正的STEMI和NISTE可能会很困难。应当记住，出现胸痛且表现为NISTE良性模式（例如，“早期复极”或继发于左心室肥厚的STE）的患者，可能存在真正的缺血性疼痛，并且在基线良性模式之上还可能发生非STE心肌梗死甚至STEMI。在“现实世界”中，医生根据所呈现的ECG模式区分NISTE和STEMI的能力差异很大，并且取决于患者群体中基线NISTE的患病率。需要进一步研究来评估各种ECG标准准确区分STEMI和NISTE的能力。
