Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Health Science University, Istanbul, Turkey.
Ann Noninvasive Electrocardiol. 2020 Mar;25(2):e12725. doi: 10.1111/anec.12725. Epub 2019 Nov 10.
Although patients with tombstoning ST-segment elevation (Tomb-ST) usually have poor in-hospital and short-term survival rates, no studies have examined the long-term clinical outcomes and prognosis of ST-segment elevation myocardial infarction (STEMI) patients who have this electrocardiographic pattern. Therefore, we aimed to evaluate the long-term clinical events and mortality of such patients in this study.
In this retrospective analysis, we included 335 consecutive patients who were diagnosed with acute anterior wall-STEMI from January 2015 to June 2018. The criteria for the definition of Tomb-ST were accepted as provided in a previous study. Endpoints of the study were the incidence of significant in-hospital and long-term major adverse clinical events (MACE) including the composite of total death, myocardial reinfarction, and hospitalizations due to heart failure.
Patients who presented with Tomb-ST had significantly higher in-hospital and long-term mortality (10% [n = 12 patients] vs. 2.3% [n = 5 patients]; p < 0.001and 6.5% [n = 7 patients] vs. 1.9% [n = 4 patients]; p = .04, respectively). In a multivariate traditional and penalized Cox proportional hazard regression analysis, this type of electrocardiographic pattern was found as independent predictor of long-term MACE (Odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.91-7.63, p < .001 and OR: 4.36, 95% CI: 1.97-9.66, p < .001, respectively).
In the present study, we observed that the presence of Tomb-ST might be an independent predictor of long-term MACE in STEMI patients. To the best of our knowledge, this is the first study to evaluate the long-term MACE of such patients.
尽管 Tombstoning ST 段抬高（Tomb-ST）患者通常院内和短期生存率较差，但尚无研究探讨具有这种心电图模式的 ST 段抬高型心肌梗死（STEMI）患者的长期临床结局和预后。因此，我们旨在评估此类患者的长期临床事件和死亡率。
在这项回顾性分析中，我们纳入了 2015 年 1 月至 2018 年 6 月连续诊断为急性前壁 STEMI 的 335 例患者。Tomb-ST 的定义标准采用既往研究中的标准。本研究的终点是重大院内和长期不良临床事件（MACE）的发生率，包括总死亡率、心肌再梗死和心力衰竭住院的复合终点。
出现 Tomb-ST 的患者院内和长期死亡率均显著升高（10%[n=12 例] vs. 2.3%[n=5 例]；p<0.001 和 6.5%[n=7 例] vs. 1.9%[n=4 例]；p=0.04）。在多变量传统和惩罚 Cox 比例风险回归分析中，这种心电图模式被发现是长期 MACE 的独立预测因素（优势比[OR]：3.82，95%置信区间[CI]：1.91-7.63，p<0.001 和 OR：4.36，95%CI：1.97-9.66，p<0.001）。
在本研究中，我们观察到 Tomb-ST 的存在可能是 STEMI 患者长期 MACE 的独立预测因素。据我们所知，这是评估此类患者长期 MACE 的第一项研究。
