Patel D, Mulcahy D, Curzen N, Sullivan A, Cunningham D, Sparrow J, Wright C, Quyyumi A, Fox K
Department of Non-Invasive Cardiology Royal Brompton National Heart and Lung Hospital, London.
Br Heart J. 1993 Oct;70(4):337-41. doi: 10.1136/hrt.70.4.337.
To assess the long-term (four to 10 years) prognostic significance of transient ST segment changes on ambulatory ST segment monitoring after coronary artery bypass grafting (CABG).
76 patients (67 men, nine women) underwent CABG between 1982 and 1984 (n = 31) and between 1987 and 1988 (n = 45) and at a mean age of 57. All underwent 48 hours of ambulatory ST segment monitoring at a mean of 19 weeks after surgery. The results were available for assessment. All general practitioners were contacted and patients' notes reviewed. Patients were contacted by telephone. Details were recorded of intervening events (acute myocardial infarction, unstable angina, need for further revascularisation, and deaths). Event free survival curves were produced for those with and without transient ST segment changes during routine postoperative ambulatory ST segment monitoring.
During 3213 hours of monitoring after CABG, 21 (27.6%) of 76 patients had transient ST segment changes, of which 70% were silent. Over a mean 70 month follow up period, patients with such ischaemic changes were no more likely to have either an objective (myocardial infarction or cardiac death) or subjective (unstable angina or another revascularisation) event than those patients without ischaemic changes. This finding was the same in patients operated on between 1987 and 1988 and between 1982 and 1984.
Although ambulatory ST segment monitoring is becoming increasingly popular in some countries as a routine investigation for ischaemia in various coronary subgroups, the findings of such an investigation, when performed after CABG, do not help to identify a subgroup more likely to have an adverse outcome during up to 10 years of follow up. There seems to be no reason to perform this investigation after surgery, and particularly to refer patients for reinvestigation because of the detection of predominantly silent ST segment changes of uncertain relevance.
评估冠状动脉旁路移植术（CABG）后动态ST段监测中短暂ST段改变的长期（4至10年）预后意义。
76例患者（67例男性，9例女性）于1982年至1984年（n = 31）以及1987年至1988年（n = 45）接受CABG，平均年龄57岁。所有患者均在术后平均19周时接受了48小时的动态ST段监测，结果可供评估。联系了所有全科医生并查阅了患者病历，通过电话联系患者，记录干预事件（急性心肌梗死、不稳定型心绞痛、再次血管重建需求及死亡）的详细情况。为术后动态ST段监测期间出现和未出现短暂ST段改变的患者绘制无事件生存曲线。
在CABG后的3213小时监测中，76例患者中有21例（27.6%）出现短暂ST段改变，其中70%为无症状性改变。在平均70个月的随访期内，有此类缺血性改变的患者与无缺血性改变的患者相比，发生客观事件（心肌梗死或心源性死亡）或主观事件（不稳定型心绞痛或再次血管重建）的可能性并无差异。1987年至1988年手术的患者与1982年至1984年手术的患者结果相同。
尽管在一些国家，动态ST段监测作为各类冠状动脉亚组缺血情况的常规检查越来越普遍，但CABG后进行此项检查的结果无助于识别在长达10年的随访期间更可能出现不良结局的亚组。术后似乎没有理由进行此项检查，尤其是不应因检测到主要为无症状且相关性不确定的ST段改变而让患者接受再次检查。
