Kytö Ville, Sipilä Jussi, Rautava Päivi
Heart Center, Division of Clinical Neurosciences, Neurology and Clinical Research Center, Turku University Hospital, Turku, Finland; PET Center, Medicine, Neurology and Public Health, University of Turku, Turku, Finland.
PLoS One. 2014 Sep 25;9(9):e108440. doi: 10.1371/journal.pone.0108440. eCollection 2014.
Emergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known.
To determine likelihood and patient features associated with ST-elevations in myocardial infarction.
Nationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland.
Hospitalized care.
68,162 consecutive patients aged ≥ 30 with myocardial infarction.
Likelihood and patient features associated with presence of ST-elevations.
Myocardial infarction presented with ST-elevation in 37.5% (CI 37.0-37.9%) and without in 62.5% (CI 61.9-63.1%) of patients, p<0.0001. Majority of patients aged 30-59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0-16.2%) per 10 year increase (p<0.0001). Men aged 40-79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11-15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis.
Myocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.
心肌梗死的紧急治疗方案以心电图中是否存在ST段抬高为指导。然而，不同人群中ST段表现的发生率及相关因素尚不完全清楚。
确定心肌梗死中与ST段抬高相关的可能性及患者特征。
在芬兰进行的一项为期八年的全国性登记研究，纳入22家设有血管实验室的医院。
住院治疗。
68162例年龄≥30岁的连续性心肌梗死患者。
与ST段抬高相关的可能性及患者特征。
37.5%（置信区间37.0 - 37.9%）的心肌梗死患者出现ST段抬高，62.5%（置信区间61.9 - 63.1%）的患者未出现ST段抬高，p<0.0001。多数30 - 59岁的心肌梗死患者有ST段抬高，但在八旬老人中，ST段抬高的比例仅为24.7%。每增加10岁，ST段抬高的发生率估计下降15.6%（置信区间15.0 - 16.2%）（p<0.0001）。40 - 79岁男性发生ST段抬高型心肌梗死的比例显著高于女性。心肌梗死表现的性别差异随年龄增长而减小。总体而言，在调整年龄和合并症后，男性出现ST段抬高的相对风险比女性高13%（置信区间11 - 15%，p<0.0001）。多因素分析显示，糖尿病、心房颤动、外周或脑动脉疾病、慢性肺病、恶性肿瘤及肾功能不全与心肌梗死时无ST段抬高相关。
男性心肌梗死表现为ST段抬高更为常见。ST段抬高的发生率随年龄增长而降低。糖尿病、心房颤动、外周或脑动脉疾病、慢性肺病、恶性肿瘤及肾功能不全与心肌梗死时无ST段抬高相关。这些发现可能有助于预测心肌梗死患者ST段抬高的可能性。
