入院心电图出现早期复极与接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者的长期死亡率和主要不良心血管事件相关。
Presence of early repolarization on admission electrocardiography is associated with long-term mortality and MACE in patients with STEMI undergoing primary percutaneous intervention.
作者信息
Ozcan Kazım Serhan, Güngör Barış, Tatlısu Mustafa Adem, Osmonov Damirbek, Ekmekçi Ahmet, Çalık Ali Nazmi, Aruğarslan Emre, Zengin Ahmet, Bolca Osman, Eren Mehmet, Erdinler İzzet
机构信息
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, 34668 Istanbul, Turkey.
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, 34668 Istanbul, Turkey.
出版信息
J Cardiol. 2014 Sep;64(3):164-70. doi: 10.1016/j.jjcc.2013.12.007. Epub 2014 Feb 5.
BACKGROUND
Early repolarization (ER) is associated with increased risk of sudden cardiac death and ventricular fibrillation (VF) in patients with/without structural heart disease. In this trial we examined the short- and long-term prognostic value of ER on admission electrocardiogram (ECG) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
METHOD
Consecutive 521 patients with acute STEMI who underwent primary PCI were enrolled prospectively. Twelve-lead ECGs obtained during the initial diagnosis were scanned and stored digitally. The leads showing the typical ST segment elevation due to the acute infarction were excluded and the remaining ECG leads were included in the analysis for the presence of ER.
RESULTS
The study group included 61 STEMI patients (55 male; mean age 57.6±12.6 years) with ER and 460 STEMI patients (378 male; mean age 57.1±12.5) without ER on ECG. In the ER group, 14 patients (22.9%) had notching, 10 patients (16.4%) had slurring, and 37 patients (60.7%) had only J-point elevation. When analyzing regional leads, ER was observed mostly in inferior leads (n=40, 65.6%). During the hospitalization period, ventricular tachycardia or VF occurred more frequently in the ER group (19.6% vs. 10.9%; p=0.04) and 6 patients (6.9%) from the ER group and 14 patients (3%) from the control group died (p=0.01). During a follow-up period of 21.1±10.2 months, mortality was significantly higher in the ER group (12.7% vs. 4.2%; p=0.01). When total mortality rates were considered, highest mortality was observed in patients with notching pattern (5/14 subjects; 35.7%) when compared to patients with slurring (3/10 subjects; 30%), patients with only J-point elevation patterns (5/37subjects; 13.5%) and the control group (33/460 subjects; 7.1%). Presence of notching and slurring pattern on admission ECG was found as independent predictors of long-term mortality; whereas presence of only J-point elevation was not.
CONCLUSION
Presence of ER pattern in admission ECG in patients with STEMI is associated with both in-hospital and long-term mortality.
背景
早期复极（ER）与有/无结构性心脏病患者的心源性猝死和室颤（VF）风险增加相关。在本试验中，我们研究了急诊经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者入院心电图（ECG）上ER的短期和长期预后价值。
方法
前瞻性纳入连续521例行急诊PCI的急性STEMI患者。对初始诊断时获得的12导联心电图进行扫描并数字存储。排除因急性梗死出现典型ST段抬高的导联，其余ECG导联纳入ER存在情况的分析。
结果
研究组包括61例心电图有ER的STEMI患者（55例男性；平均年龄57.6±12.6岁）和460例心电图无ER的STEMI患者（378例男性；平均年龄57.1±12.5岁）。在ER组中，14例患者（22.9%）有切迹，10例患者（16.4%）有顿挫，37例患者（60.7%）仅有J点抬高。分析区域性导联时，ER多见于下壁导联（n = 40，65.6%）。住院期间，ER组室性心动过速或VF发生率更高（19.6%对10.9%；p = 0.04），ER组6例患者（6.9%）和对照组14例患者（3%）死亡（p = 0.01）。在21.1±10.2个月的随访期内，ER组死亡率显著更高（12.7%对4.2%；p = 0.01）。考虑总死亡率时，切迹型患者死亡率最高（5/14例；35.7%），与顿挫型患者（3/10例；30%）、仅有J点抬高型患者（5/37例；13.5%）及对照组（33/460例；7.1%）相比。入院ECG上有切迹和顿挫型被发现是长期死亡率的独立预测因素；而仅有J点抬高则不是。
结论
STEMI患者入院ECG上有ER模式与院内及长期死亡率相关。
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