Willich S N, Stone P H, Muller J E, Tofler G H, Crowder J, Parker C, Rutherford J D, Turi Z G, Robertson T, Passamani E
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Am Heart J. 1987 Nov;114(5):1110-9. doi: 10.1016/0002-8703(87)90186-4.
To determine the significance of the direction of ST segment deviation on admission of patients who evolved non-Q wave myocardial infarction (MI), 97 patients with initial ST segment depression were compared to 207 patients with initial ST segment elevation. Patients with ST segment depression developed smaller infarcts than those with ST segment elevation (creatine kinase MB isoenzyme 8.2 vs 13.3 gmEq/m2, p less than 0.002), but had a lower left ventricular ejection fraction on admission (44% vs 51%, p less than 0.001), more in-hospital complications, and a higher cumulative 1-year mortality (29% vs 11%, p less than 0.001) that could be accounted for by an excess of adverse baseline characteristics. Although a severity index (combining magnitude and extent of the initial ST segment deviation) was not useful for discriminating prognosis of patients with non-Q wave MI who presented with ST segment depression, it was useful in identifying a subgroup of patients with ST segment elevation with an adverse prognosis. The poor outcome of patients with non-Q wave MI presenting with either ST segment depression or severe ST segment elevation on admission suggests that patients in these subgroups should receive close surveillance and should possibly be considered for aggressive therapy.
为了确定非Q波心肌梗死（MI）患者入院时ST段偏移方向的意义，对97例初始ST段压低的患者与207例初始ST段抬高的患者进行了比较。ST段压低的患者梗死面积小于ST段抬高的患者（肌酸激酶MB同工酶分别为8.2和13.3 gmEq/m2，p<0.002），但入院时左心室射血分数较低（分别为44%和51%，p<0.001），住院并发症更多，累积1年死亡率更高（分别为29%和11%，p<0.001），这可能是由于不良基线特征过多所致。尽管严重程度指数（结合初始ST段偏移的幅度和范围）对鉴别出现ST段压低的非Q波MI患者的预后无用，但它有助于识别预后不良的ST段抬高患者亚组。入院时出现ST段压低或严重ST段抬高的非Q波MI患者预后较差，这表明这些亚组的患者应接受密切监测，并可能应考虑积极治疗。
