Katz R, Conroy R M, Robinson K, Mulcahy R
Br Heart J. 1986 May;55(5):423-7. doi: 10.1136/hrt.55.5.423.
The relations between reciprocal ST segment depression in the electrocardiogram and infarct size and 10 year prognosis were studied in 315 patients who survived for at least 28 days after a first anterior or inferior myocardial infarction. ST depression was more common in inferior infarcts (72%) than in anterior (37%) ones. It occurred more frequently in complicated infarcts and in the presence of considerable ST elevation. Patients experiencing second or third degree heart block were significantly more likely to show reciprocal changes. The rise in peak cardiac enzyme concentration was higher in patients showing ST depression. In patients with ST depression, peak creatine kinase concentration was 46% higher, aspartate aminotransferase was 39% higher, and lactate dehydrogenase 29% higher after correction for site and complications. A discriminant function analysis selected infarct site, peak aspartate aminotransferase, and magnitude of ST elevation as predictors of the occurrence of ST depression. Age, severity, and smoking status did not significantly improve discrimination. Despite larger increases in peak enzyme concentrations patients with ST depression had marginally fewer subsequent episodes of unstable angina or fatal or non-fatal infarction and a marginally lower 10 year death rate. Neither difference was statistically significant. ST depression occurring early in the acute phase of myocardial infarction is likely to be a reflection of electrophysiological changes taking place at the site of the infarct that is manifested in the contralateral surface of the heart. Other causes, however, such as transient ischaemia at the site of the reciprocal changes or extension of the infarct to contiguous areas cannot be excluded in all cases.
对315例首次发生前壁或下壁心肌梗死后至少存活28天的患者，研究了心电图中ST段压低与梗死面积及10年预后之间的关系。下壁梗死患者中ST段压低更为常见（72%），高于前壁梗死患者（37%）。在合并症较多的梗死以及存在显著ST段抬高时，ST段压低更易出现。发生二度或三度房室传导阻滞的患者出现对应性改变的可能性显著更高。ST段压低患者的心肌酶峰值浓度升高幅度更大。在校正梗死部位和合并症后，ST段压低患者的肌酸激酶峰值浓度高46%，天冬氨酸转氨酶高39%，乳酸脱氢酶高29%。判别函数分析选择梗死部位、天冬氨酸转氨酶峰值及ST段抬高幅度作为ST段压低发生的预测因素。年龄、病情严重程度及吸烟状况并不能显著提高判别能力。尽管ST段压低患者的酶峰值浓度升高幅度更大，但随后不稳定型心绞痛发作或致命或非致命性梗死发作略少，10年死亡率略低。但两者差异均无统计学意义。心肌梗死急性期早期出现的ST段压低可能反映了梗死部位发生的电生理变化，这种变化在心脏对侧表面表现出来。然而，在所有病例中不能排除其他原因，如对应性改变部位的短暂性缺血或梗死扩展至相邻区域。
