Mickley H, Pless P, Nielsen J R, Møller M
Department of Cardiology, Odense University Hospital, Denmark.
Eur Heart J. 1993 Jan;14(1):18-25. doi: 10.1093/eurheartj/14.1.18.
In a prospective study of 123 consecutive survivors of a first myocardial infarction (43 non-Q wave, 80 Q wave), we determined the total residual ischaemic burden by use of pre-discharge maximal exercise testing and post-discharge 36 h ambulatory ST-segment monitoring initiated 11 +/- 5 days after the infarction. The prevalence of exercise-induced ischaemic manifestations in the infarct types was similar: chest pain 14% vs 16% and ST-segment depression 54% vs 54%. The ischaemic threshold did not differ either (heart rate at 1 mm of ST-segment depression 120 +/- 27 vs 119 +/- 25 beats.min-1). During early post-discharge daily activities, more patients with non-Q wave infarction demonstrated transient episodes of ST-segment depression: 28% vs 14% (ns). Furthermore, ischaemic episodes were significantly longer (42.5 +/- 50.1 vs 22.0 +/- 20.6 min; P < 0.001), and the ischaemic threshold was significantly lower in non-Q wave infarction (heart rate at onset of ST-segment depression 84 +/- 11 vs 88 +/- 9 beats.min-1; P < 0.05). During 3.5 +/- 0.9 years of follow-up the proportion of patients with > or = 1 ischaemic event (non-fatal reinfarction, angina pectoris, revascularization) was significantly higher in non-Q wave infarction (51%) as compared to Q wave infarction (31%) (P < 0.05). In both infarct types the presence of ST-segment depression on ambulatory recording and exercise testing significantly predicted the development of future angina pectoris, whereas patients at increased risk for subsequent non-fatal reinfarction or cardiac death were not identified.
在一项对123例首次心肌梗死连续幸存者（43例非Q波梗死，80例Q波梗死）的前瞻性研究中，我们通过出院前最大运动试验以及梗死发生11±5天后开始的出院后36小时动态ST段监测来确定总的残余缺血负荷。梗死类型中运动诱发缺血表现的发生率相似：胸痛分别为14%对16%，ST段压低分别为54%对54%。缺血阈值也无差异（ST段压低1毫米时的心率分别为120±27次/分钟对119±25次/分钟）。在出院后早期日常活动期间，更多非Q波梗死患者出现ST段压低的短暂发作：28%对14%（无显著性差异）。此外，缺血发作明显更长（42.5±50.1分钟对22.0±20.6分钟；P<0.001），且非Q波梗死的缺血阈值明显更低（ST段压低开始时的心率分别为84±11次/分钟对88±9次/分钟；P<0.05）。在3.5±0.9年的随访期间，发生≥1次缺血事件（非致命性再梗死、心绞痛、血管重建）的患者比例在非Q波梗死中（51%）显著高于Q波梗死（31%）（P<0.05）。在两种梗死类型中，动态记录和运动试验中ST段压低的存在均显著预测了未来心绞痛的发生，而未识别出随后非致命性再梗死或心源性死亡风险增加的患者。
