Nyman I, Areskog M, Areskog N H, Swahn E, Wallentin L
Department of Internal Medicine, District Hospital, Eksjo, Sweden.
J Intern Med. 1993 Sep;234(3):293-301. doi: 10.1111/j.1365-2796.1993.tb00746.x.
To determine the possibility of very early prognostic stratification based on electrocardiograms (ECGs) at rest and/or cardiac enzyme levels after an episode of suspected unstable coronary heart disease.
Men with suspected unstable angina or non-Q-wave myocardial infarction were studied in the coronary care units of eight hospitals. The ECGs at rest and creatinine kinase were followed.
In total 911 men were followed for 12 months. Of 8136 consecutively admitted, 3365 fulfilled the inclusion criteria. Excluded were 2454 patients, mainly because of a larger myocardial damage, signs of myocardial dysfunction, other serious cardiac or non-cardiac disease or an ECG not possible to interpret regarding ST-T-segment changes in the precordial leads.
End-points at follow-up were cardiac death, myocardial infarction and severe (class III or IV) angina.
Compared to patients with normal a ECG who had an 8% 1-year risk of myocardial infarction or death, the risk with isolated negative T waves was 14% (P < 0.05), ST elevation 16% (P < 0.05), ST depression 18% (P < 0.01) and the combination of ST elevation and ST depression 26% (P < 0.001). The only finding related to future severe angina was ST depression. The risk of cardiac events was comparably elevated in patients with anterior or inferior site of ECG changes. Cardiac enzyme levels had no predictive value regarding future events.
Electrocardiograms at rest obtained during the initial days of hospitalization provide very early and valuable prognostic information in men admitted with suspected unstable coronary heart disease.
确定在疑似不稳定型冠心病发作后，基于静息心电图（ECG）和/或心肌酶水平进行极早期预后分层的可能性。
对八家医院冠心病监护病房中疑似不稳定型心绞痛或非Q波心肌梗死的男性患者进行研究。对静息心电图和肌酸激酶进行跟踪观察。
共对911名男性患者进行了12个月的随访。在连续入院的8136名患者中，3365名符合纳入标准。排除了2454名患者，主要原因是心肌损伤较大、心肌功能障碍迹象、其他严重的心脏或非心脏疾病，或无法根据胸前导联ST - T段变化解读心电图。
随访终点为心源性死亡、心肌梗死和重度（III或IV级）心绞痛。
与静息心电图正常且1年内心肌梗死或死亡风险为8%的患者相比，单纯T波倒置的风险为14%（P < 0.05），ST段抬高为16%（P < 0.05），ST段压低为18%（P < 0.01），ST段抬高与压低并存为26%（P < 0.001）。与未来重度心绞痛相关的唯一发现是ST段压低。心电图改变位于前壁或下壁的患者发生心脏事件的风险同样升高。心肌酶水平对未来事件无预测价值。
在住院初期获得的静息心电图为疑似不稳定型冠心病入院患者提供了极早期且有价值的预后信息。
