Baker J T, Bramlet D A, Lester R M, Harrison D G, Roe C R, Cobb F R
Circulation. 1982 May;65(5):918-23. doi: 10.1161/01.cir.65.5.918.
Myocardial infarct extension, defined as reelevation or reappearance of creatine phosphokinase-MB (CK-MB) 48 hours after the onset of symptoms, was evaluated prospectively in 56 consecutive patients with acute myocardial infarction. Myocardial infarct extension occurred in eight patients (14%). The sensitivity, specificity and predictive accuracy in the diagnosis of myocardial infarct extension were 63%, 85% and 42%, respectively, for recurrent chest pain requiring morphine; 50%, 65% and 19% for recurrent ST-segment elevation on routine 12-lead ECGs; and 88%, 63% and 28% for reelevation of total CK. Three of the eight episodes of extension were clinically silent. Four of eight patients (50%) with extension died, compared with one of 46 patients (2%) without extension (p = 0.0009). CK-MB persisted for 72 hours or longer in 16 patients and identified seven of eight patients who subsequently had infarct extension. We conclude that myocardial infarct extension is an infrequent complication of acute myocardial infarction and is associated with a very high mortality rate. Persistence of CK-MB for 72 hours or more identifies a subgroup of patients at high risk for subsequent infarct extension and death.
心肌梗死扩展定义为症状发作48小时后肌酸磷酸激酶同工酶（CK-MB）再次升高或再次出现，我们对56例连续的急性心肌梗死患者进行了前瞻性评估。8例患者（14%）发生了心肌梗死扩展。对于需要吗啡治疗的复发性胸痛，诊断心肌梗死扩展的敏感性、特异性和预测准确性分别为63%、85%和42%；对于常规12导联心电图上的复发性ST段抬高，分别为50%、65%和19%；对于总CK再次升高，分别为88%、63%和28%。8次扩展发作中有3次临床上无症状。8例发生扩展的患者中有4例（50%）死亡，而46例未发生扩展的患者中有1例（2%）死亡（p = 0.0009）。16例患者的CK-MB持续72小时或更长时间，其中8例随后发生梗死扩展的患者中有7例被识别出来。我们得出结论，心肌梗死扩展是急性心肌梗死的一种罕见并发症，且与极高的死亡率相关。CK-MB持续72小时或更长时间可识别出随后发生梗死扩展和死亡风险较高的亚组患者。
