Mauri F, Maggioni A P, Franzosi M G, de Vita C, Santoro E, Santoro L, Giannuzzi P, Tognoni G
J Am Coll Cardiol. 1994 Sep;24(3):600-7. doi: 10.1016/0735-1097(94)90003-5.
This analysis aimed to evaluate in a large patient cohort the relation between ST segment alterations after fibrinolytic therapy for acute myocardial infarction and 1) the combined end point of in-hospital mortality plus clinical congestive heart failure or extensive left ventricular damage, and 2) mortality 30 and 180 days after randomization.
Angina relief, enzyme release acceleration and ST segment normalization are related to coronary artery reperfusion and prognosis. Electrocardiographic (ECG) evaluation before and after fibrinolytic drug administration has been used to predict short- and long-term clinical outcome in acute myocardial infarction.
Patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2) trial underwent a standard ECG on admission and after 4 h of alteplase or streptokinase therapy; 7,426 recordings were suitable for ST segment analysis. A decrease > or = 50% in the sum of ST segment elevation in all ECG leads was adopted as the cutoff for predicting coronary artery patency. Recanalization was deemed to have occurred in 4,951 patients (group A) versus 2,475 patients without reperfusion (group B).
Group A patients experienced a lower incidence of the combined end point than did group B patients (16.2% vs. 22.9%, respectively), as well as of all its components (death, clinical heart failure, ejection fraction < 35%, injured myocardial segment > 45%, QRS score > 10). Thirty- and 180-day mortality rates were lower in group A than group B (3.5% and 5.7% vs. 7.4% and 9.9%, respectively); relative risk (Cox) was 0.46 (95% confidence interval [CI] 0.37 to 0.57) for 30-day and 0.58 (95% CI 0.48 to 0.70) for 180-day mortality. Patients in group A had significantly less ventricular fibrillation and sustained ventricular tachycardia but more ischemic episodes (early recurrent angina plus myocardial infarction recurrence).
A simple, inexpensive instrumental evaluation, unaffected by different epidemiologic and clinical characteristics of the population analyzed, can allow early assessment of the effectiveness of fibrinolytic treatment with respect to the main clinical outcomes.
本分析旨在评估大量患者队列中急性心肌梗死溶栓治疗后ST段改变与以下两项指标的关系：1）院内死亡加临床充血性心力衰竭或广泛左心室损害的联合终点；2）随机分组后30天和180天的死亡率。
心绞痛缓解、酶释放加速和ST段正常化与冠状动脉再灌注及预后相关。溶栓药物给药前后的心电图（ECG）评估已用于预测急性心肌梗死的短期和长期临床结局。
参与意大利心肌梗死存活研究组（GISSI - 2）试验的患者在入院时及接受阿替普酶或链激酶治疗4小时后接受标准心电图检查；7426份记录适合进行ST段分析。采用所有心电图导联ST段抬高总和下降≥50%作为预测冠状动脉通畅的截断值。4951例患者（A组）被认为发生再通，2475例未再通患者（B组）。
A组患者联合终点的发生率低于B组患者（分别为16.2%和22.9%），其所有组成部分（死亡、临床心力衰竭、射血分数<35%、受损心肌节段>45%、QRS评分>10）也是如此。A组30天和180天死亡率低于B组（分别为3.5%和5.7%，对比7.4%和9.9%）；30天死亡率的相对风险（Cox）为0.46（95%置信区间[CI]0.37至0.57），180天死亡率为0.58（95%CI 0.48至0.70）。A组患者室颤和持续性室性心动过速明显较少，但缺血发作（早期复发性心绞痛加心肌梗死复发）较多。
一种简单、廉价的仪器评估，不受所分析人群不同流行病学和临床特征的影响，可以对溶栓治疗相对于主要临床结局的有效性进行早期评估。
