Sharkey S W, Apple F S, Elsperger K J, Tilbury R T, Miller S, Fjeldos K, Asinger R W
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
Am Heart J. 1988 Nov;116(5 Pt 1):1207-11. doi: 10.1016/0002-8703(88)90441-3.
This study compared the time from the onset of symptoms to the peak of the creatine kinase-myocardial band (CK-MB) in 34 consecutive patients with acute myocardial infarction. Patients were separated into two groups: group 1 (n = 21) had diagnostic (greater than or equal to 0.1 mV) ST segment elevation on the initial ECG, and group 2 (n = 13) did not have diagnostic ST segment elevation on the initial ECG. In group 1 the time to the peak CK-MB was 16.2 +/- 50 hours vs 10.0 +/- 2.0 hours for group 2 (p = 0.0001). Peak CK-MB was 331 +/- 276 IU/L in group 1 vs 81 +/- 54 IU/L in group 2 (p less than 0.005). In group 1 there were 16 patients who subsequently had a Q wave myocardial infarction as opposed to one patient in group 2 (p = 0.0001). Patients who do not have diagnostic ST segment elevation on the initial ECG have an early but low peak of CK-MB and typically have a non-Q wave infarction. These findings are consistent with early spontaneous restoration of blood flow during the infarction process in these patients. This early restoration of blood flow may provide the substrate for the high incidence of recurrent ischemic events noted in patients with non-Q wave myocardial infarction.
本研究比较了34例急性心肌梗死连续患者从症状出现到肌酸激酶同工酶（CK-MB）峰值的时间。患者被分为两组：第1组（n = 21）初始心电图有诊断性（大于或等于0.1 mV）ST段抬高，第2组（n = 13）初始心电图无诊断性ST段抬高。第1组达到CK-MB峰值的时间为16.2±5.0小时，而第2组为10.0±2.0小时（p = 0.0001）。第1组CK-MB峰值为331±276 IU/L，第2组为81±54 IU/L（p＜0.005）。第1组有16例患者随后发生Q波心肌梗死，而第2组只有1例（p = 0.0001）。初始心电图无诊断性ST段抬高的患者CK-MB峰值出现早但较低，且通常发生非Q波梗死。这些发现与这些患者梗死过程中早期血流自发恢复一致。这种早期血流恢复可能是无Q波心肌梗死患者复发性缺血事件高发的原因。
