Currie P, Ashby D, Saltissi S
Cardio-Respiratory Department, Royal Liverpool University Hospital, United Kingdom.
Am J Cardiol. 1993 Apr 1;71(10):773-7. doi: 10.1016/0002-9149(93)90822-t.
The prognostic value of ambulatory ST-segment monitoring after myocardial infarction was prospectively assessed in 203 patients both early (mean 6 days, n = 201) and late (38 days, n = 177). During at least 1 year of follow-up there were 21 cardiac deaths and 44 cardiac events (death, reinfarction or coronary revascularization). ST depression was seen less often during early than late monitoring (29 of 201 [14%] vs 56 of 177 [32%]). Early ST depression was significantly associated with increased mortality (7 of 29 [24%] vs 14 of 172 [8%]) (< 0.05) and increased cardiac events (13 of 29 [45%] vs 30 of 172 [17%]) (p < 0.001) and had independent value after allowing for clinical factors and coronary prognostic indexes (adjusted relative risks 3.40 and 2.70, respectively). ST depression on late monitoring was only associated with increased cardiac events when it was: (1) frequent (e.g., > or = 3 episodes/day [10 of 31 patients, 32% vs 18 of 146, 12%]) (p < 0.01); (2) prolonged (e.g., > or = 20 minutes/day [8 of 25, 32% vs 20 of 152, 13%]) (p < 0.05); or (3) severe (e.g., maximum of > or = 1.5 mm [8 of 28, 29% vs 20 of 149, 13%]) (p < 0.05). Thus, ST depression occurs less frequently during ambulatory monitoring before discharge than during late monitoring, but is a more specific prognostic indicator; however, it is more benign during late monitoring. Ambulatory ST-segment monitoring can be used to predict prognosis in the first year after myocardial infarction, although its relative value as a screening test compared with exercise testing remains to be established.
对203例患者在心肌梗死后早期（平均6天，n = 201）和晚期（38天，n = 177）进行动态ST段监测的预后价值进行了前瞻性评估。在至少1年的随访期间，有21例心脏死亡和44例心脏事件（死亡、再梗死或冠状动脉血运重建）。早期监测时ST段压低的发生率低于晚期监测（201例中有29例[14%] vs 177例中有56例[32%]）。早期ST段压低与死亡率增加显著相关（29例中有7例[24%] vs 172例中有14例[8%]）（<0.05）和心脏事件增加相关（29例中有13例[45%] vs 172例中有30例[17%]）（p<0.001），并且在考虑临床因素和冠状动脉预后指标后具有独立价值（调整后的相对风险分别为3.40和2.70）。晚期监测时ST段压低仅在以下情况与心脏事件增加相关：（1）频繁发生（例如，≥3次/天[31例患者中有10例，32% vs 146例中有18例，12%]）（p<0.01）；（2）持续时间长（例如，≥20分钟/天[25例中有8例，32% vs 152例中有20例，13%]）（p<0.05）；或（3）严重（例如，最大压低≥1.5mm[28例中有8例，29% vs 149例中有20例，13%]）（p<0.05）。因此，出院前动态监测期间ST段压低的发生率低于晚期监测，但它是一个更具特异性的预后指标；然而，晚期监测时其预后意义较小。动态ST段监测可用于预测心肌梗死后第一年的预后，尽管与运动试验相比，其作为筛查试验的相对价值仍有待确定。
