Marshall E S, Raichlen J S, Kim S M, Intenzo C M, Sawyer D T, Brody E A, Tighe D A, Park C H
Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Am Heart J. 1995 Jul;130(1):58-66. doi: 10.1016/0002-8703(95)90236-8.
To determine the significance of ST-segment depression during adenosine perfusion imaging for predicting future cardiac events, 188 patients with interpretable electrocardiograms were assessed 1 to 3 years (mean 21.5 +/- 6.6 months) after adenosine testing. At least 1 mm of ST-segment depression was observed in 32 (17%) patients, with > or = 2 mm of ST-segment depression in 10 (5.3%). Thirty-seven cardiac events occurred during the study period: 2 cardiac deaths, 5 nonfatal myocardial infarctions, 6 admissions for unstable angina, and 24 revascularizations. Univariate predictors of events were a history of congestive heart failure, previous non-Q-wave myocardial infarction, previous coronary angioplasty, use of antianginal medication, ST-segment depression during adenosine infusion (particularly > or = 2 mm), any reversible perfusion defect, transient left ventricular cavity dilation, and the severity of perfusion defects. Multivariate analysis identified > or = 2 mm ST-segment depression as the most significant predictor of cardiac events (relative risk [RR] = 6.5; p = 0.0001). Other independent predictors of events were left ventricular dilation (RR = 3.8; p = 0.002), previous coronary angioplasty (RR = 3.3; p = 0.001), a history of non-Q-wave myocardial infarction (RR = 2.3; p = 0.01), and the presence of any reversible defect (RR = 2.0; p = 0.05). We conclude that ST-segment depression occurs uncommonly during adenosine infusion, but the presence of > or = 2 mm of ST-segment depression is an independent predictor of future cardiac events and provides information in addition to that obtained from clinical variables and the results of adenosine perfusion imaging.
为了确定腺苷灌注成像期间ST段压低对预测未来心脏事件的意义，对188例心电图可解读的患者在腺苷试验后1至3年（平均21.5±6.6个月）进行了评估。32例（17%）患者观察到至少1mm的ST段压低，10例（5.3%）患者ST段压低≥2mm。研究期间发生了37次心脏事件：2例心源性死亡、5例非致命性心肌梗死、6例因不稳定型心绞痛入院以及24次血运重建。事件的单变量预测因素包括充血性心力衰竭病史、既往非Q波心肌梗死、既往冠状动脉成形术、使用抗心绞痛药物、腺苷输注期间的ST段压低（尤其是≥2mm）、任何可逆性灌注缺损、短暂性左心室腔扩张以及灌注缺损的严重程度。多变量分析确定ST段压低≥2mm是心脏事件最显著的预测因素（相对风险[RR]=6.5；p=0.0001）。事件的其他独立预测因素包括左心室扩张（RR=3.8；p=0.002）、既往冠状动脉成形术（RR=3.3；p=0.001）、非Q波心肌梗死病史（RR=2.3；p=0.01）以及存在任何可逆性缺损（RR=2.0；p=0.05）。我们得出结论，腺苷输注期间ST段压低不常见，但ST段压低≥2mm是未来心脏事件的独立预测因素，并且除了从临床变量和腺苷灌注成像结果中获得的信息外，还能提供额外信息。
