Gottlieb S O, Gottlieb S H, Achuff S C, Baumgardner R, Mellits E D, Weisfeldt M L, Gerstenblith G
Department of Medicine, Francis Scott Key Medical Center, Baltimore, MD 21224.
JAMA. 1988 Feb 19;259(7):1030-5.
The relative prognostic significance of ischemic ST changes on two-lead continuous electrocardiographic (Holter) monitoring in 103 high-risk postinfarction patients was examined. Ischemic ST changes were detected in 30 patients, with a median number of five episodes per day and median total daily duration of 157 minutes. Only one third of these patients reported any angina in the hospital, and 28 of the 30 patients had silent ST changes on Holter monitoring. The remaining 73 patients had no ischemic ST changes on Holter monitoring. At one year, nine (30%) of 30 patients with ischemic ST changes were dead vs only eight (11%) of 73 patients without such changes. Multivariate Cox's hazard function analysis on 18 variables, including age, type of infarction, Lown and Killip class, ejection fraction, and medications, showed that the presence of ST changes on Holter monitoring was a significant predictive variable for one-year mortality in the overall study population and particularly in the subgroup of 59 patients who could not undergo early exercise treadmill testing. Thus, ischemic ST changes on Holter monitoring, the majority of which are silent, occur in nearly one third of high-risk postinfarction patients and are significantly associated with one-year mortality.
研究了103例高危心肌梗死后患者在双导联连续心电图（动态心电图）监测中缺血性ST段改变的相对预后意义。30例患者检测到缺血性ST段改变，每天发作次数中位数为5次，每日总时长中位数为157分钟。这些患者中只有三分之一在医院报告有任何心绞痛症状，30例患者中有28例在动态心电图监测时有无症状ST段改变。其余73例患者在动态心电图监测中无缺血性ST段改变。一年后，30例有缺血性ST段改变的患者中有9例（30%）死亡，而73例无此改变的患者中只有8例（11%）死亡。对包括年龄、梗死类型、Lown和Killip分级、射血分数及用药情况等18个变量进行多变量Cox风险函数分析，结果显示，在整个研究人群中，尤其是在59例无法进行早期运动平板试验的亚组患者中，动态心电图监测出现ST段改变是一年死亡率的显著预测变量。因此，动态心电图监测中的缺血性ST段改变，其中大多数为无症状性改变，发生在近三分之一的高危心肌梗死后患者中，且与一年死亡率显著相关。
