Internal medicine, Kanta-Häme Central Hospital, Hämeenlinna, Ahvenistontie 20, 13530 Hämeenlinna, Finland; Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.
Päijät-sote, Primary health care, Lahti, Keskussairaalankatu 7, 15850 Lahti, Finland.
J Electrocardiol. 2021 Sep-Oct;68:65-71. doi: 10.1016/j.jelectrocard.2021.07.015. Epub 2021 Jul 27.
The importance of the grade of ischemia (GI) ECG classification in the risk assessment of patients with STEMI has been shown previously. Grade 3 ischemia (G3I) is defined as ST-elevation with distortion of the terminal portion of the QRS complex in two or more adjacent leads, while Grade 2 ischemia (G2I) is defined as ST-elevation without QRS distortion. Our aim was to evaluate the prognostic impact of the GI classification on the outcome in patients with STEMI.
7,211 patients from the TOTAL trial were included in our study. The primary outcome was a composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year.
The primary outcome occurred in 153 of 1,563 patients (9.8%) in the G3I group vs. 364 of 5,648 patients (6.4%) in the G2I group (adjusted HR 1.27; 95% CI, 1.04 - 1.55; p=0.022). The rate of cardiovascular death (4.8% vs. 2.5%; adjusted HR 1.48; 95% CI 1.09 - 2.00; p=0.013) was also higher in patients with G3I.
G3I in the presenting ECG was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure within one year compared to patients with G2I. Patients with G3I also had a higher cardiovascular death compared to patients with G2I.
先前已经证明，缺血程度（GI）心电图分级在 STEMI 患者风险评估中的重要性。3 级缺血（G3I）定义为 ST 段抬高伴两个或多个相邻导联中 QRS 终末部分扭曲，而 2 级缺血（G2I）定义为 ST 段抬高而无 QRS 扭曲。我们的目的是评估 GI 分级对 STEMI 患者预后的影响。
我们的研究纳入了 TOTAL 试验中的 7211 例患者。主要结局是一年内心血管死亡、复发性心肌梗死（MI）、心源性休克或纽约心脏协会（NYHA）心功能 IV 级心力衰竭的复合终点。
G3I 组 153 例患者（9.8%）和 G2I 组 5648 例患者（6.4%）发生主要结局（校正 HR 1.27；95%CI，1.04-1.55；p=0.022）。G3I 组心血管死亡发生率（4.8%比 2.5%；校正 HR 1.48；95%CI，1.09-2.00；p=0.013）也更高。
与 G2I 患者相比，G3I 在初始心电图中与一年内心血管死亡、复发性 MI、心源性休克或 NYHA 心功能 IV 级心力衰竭的复合终点发生率增加相关。与 G2I 患者相比，G3I 患者的心血管死亡发生率更高。
