School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
Bankstown Hospital, Bankstown, NSW, Australia.
Intern Emerg Med. 2018 Mar;13(2):243-249. doi: 10.1007/s11739-016-1595-3. Epub 2016 Dec 31.
Current guidelines recommend that patients with non-ST elevation myocardial infarction (NSTEMI) are treated with medical management alone, or in combination with coronary angiography within 24 h. Recent research suggests that NSTEMIs show angiographic evidence of complete occlusion at rates comparable to STEMIs, suggesting a subgroup of NSTEMI patients who require urgent angiography. Novel ECG changes, termed 'STEMI-equivalents', have been described as a way of identifying this subgroup. The aim of this study was to determine whether patients with STEMI-equivalent ECG changes experience similar degrees of myocardial damage, and would thus benefit from urgent PCI. Cardiac catheterisation databases at The Wollongong Hospital were searched for STEMI, and NSTEMI patients with complete occlusion of the culprit vessel, between January 2011 and December 2013. A total of 1429 patients underwent angiography during this time period. Of these, 220 were eligible for ECG analysis. We found 10-25% of NSTEMIs with 'STEMI equivalent' ECG changes correlated with complete vessel occlusion on angiography. These patients demonstrated equivalent initial troponin readings. Recognition of STEMI-equivalents represent a chance for earlier intervention with prompt coronary angiography, as these findings are often associated with complete occlusion of the culprit vessel. These findings provide further evidence supporting the potential inclusion of STEMI-equivalents in future ACS guidelines.
目前的指南建议非 ST 段抬高型心肌梗死（NSTEMI）患者单独接受药物治疗，或在 24 小时内联合进行冠状动脉造影。最近的研究表明，NSTEMI 患者的血管造影证据显示完全闭塞的发生率与 STEMI 相当，这表明需要紧急进行血管造影的 NSTEMI 患者亚组。新型心电图改变，称为“STEMI 等效”，已被描述为识别该亚组的一种方法。本研究旨在确定是否具有 STEMI 等效心电图改变的患者经历相似程度的心肌损伤，从而受益于紧急 PCI。2011 年 1 月至 2013 年 12 月期间，在卧龙岗医院的心脏导管插入术数据库中搜索 STEMI 和 NSTEMI 患者，其罪犯血管完全闭塞。在此期间，共有 1429 名患者接受了血管造影。其中，有 220 名患者符合心电图分析条件。我们发现，10-25%的 NSTEMI 患者具有“STEMI 等效”心电图改变，与血管造影上的完全血管闭塞相关。这些患者的初始肌钙蛋白读数相当。识别 STEMI 等效代表了更早进行冠状动脉造影干预的机会，因为这些发现通常与罪犯血管的完全闭塞有关。这些发现为未来 ACS 指南中纳入 STEMI 等效提供了进一步的证据支持。
