Badir B F, Nasmith J B, Dutoy J L, Dubé B, Cardinal R, LeBlanc A R, Nadeau R
Research Centre, Hôpital du Sacré-Coeur de Montréal, Québec.
Can J Cardiol. 1995 Jul-Aug;11(7):545-52.
A noninvasive, real time method is needed to identify failures of thrombolysis and evaluate new treatments in acute myocardial infarction (MI).
To study XYZ monitored ST segment evolution during thrombolysis in acute MI and to examine the correlation of ST parameters to outcome.
Thirty-five patients receiving tissue plasminogen activator (tPA) (n = 18) or streptokinase (SK) (n = 17) for acute MI were monitored by vector-cardiography during the first 12 h of thrombolytic therapy. Computer constructed ST vector magnitude (ST-VM) trends were analyzed for 0.5 or greater decline from the initial ST amplitude (IA) lasting for 10 mins or longer (ST response) and for ST re-elevation 0.75 IA or more following ST decline. The degree of ST response, time from treatment onset and ST-VM re-elevation were correlated to peak creatine phosphokinase (CPK), left ventricular ejection fraction (EF) and final ST-VM.
The presence of an ST response correlated with a lower peak CPK (2691 +/- 1625 versus 4057 +/- 1622 U/L, P = 0.043) and tended to higher EF (0.48 +/- 0.11 versus 0.36 +/- 0.09, P = 0.057). The ST responder group had fewer patients with ST re-elevation than the group of nonresponders (13 of 30 versus five of five patients, P = 0.041). Moreover, ST response before 120 mins was associated with lower peak CPK (2089 +/- 1299 versus 3367 +/- 177 U/L, P = 0.02) and better EF (0.54 +/- 0.06 versus 0.41 +/- 0.12, P = 0.02) compared with later or no ST response. The degree of ST response correlated significantly with a lower ST-VM during the last hour (r = -0.744, P = 0.001). ST trends showed no significant differences between treatment groups (tPA versus SK). The tPA group, however, tended to an overall earlier ST response (117 +/- 75 versus 163 +/- 64 mins, P = 0.13).
Early ST-VM trends are closely associated with electrocardiographic and clinical outcome and may provide a basis for clinical management, therapeutic comparisons and better insight into thrombolysis in MI.
需要一种非侵入性的实时方法来识别溶栓失败情况并评估急性心肌梗死（MI）的新治疗方法。
研究急性心肌梗死溶栓期间XYZ监测的ST段演变，并检查ST参数与预后的相关性。
35例接受组织纤溶酶原激活剂（tPA）（n = 18）或链激酶（SK）（n = 17）治疗急性心肌梗死的患者在溶栓治疗的前12小时通过心电向量图进行监测。分析计算机构建的ST向量幅度（ST-VM）趋势，即从初始ST幅度（IA）下降0.5或更大且持续10分钟或更长时间（ST反应），以及ST下降后ST再抬高0.75 IA或更多。ST反应程度、治疗开始时间和ST-VM再抬高与肌酸磷酸激酶（CPK）峰值、左心室射血分数（EF）和最终ST-VM相关。
存在ST反应与较低的CPK峰值相关（2691±1625对4057±1622 U/L，P = 0.043），且EF有升高趋势（0.48±0.11对0.36±0.09，P = 0.057）。ST反应组ST再抬高的患者少于无反应组（30例中的13例对5例中的5例，P = 0.041）。此外，与较晚或无ST反应相比，120分钟前出现ST反应与较低的CPK峰值（2089±1299对3367±177 U/L，P = 0.02）和更好的EF（0.54±0.06对0.41±0.12，P = 0.02）相关。ST反应程度与最后一小时较低的ST-VM显著相关（r = -0.744，P = 0.001）。治疗组之间（tPA与SK）的ST趋势无显著差异。然而，tPA组总体上ST反应倾向于更早（117±75对163±64分钟，P = 0.13）。
早期ST-VM趋势与心电图和临床预后密切相关，可为临床管理、治疗比较以及更好地了解心肌梗死溶栓提供依据。
