Peterson E D, Hathaway W R, Zabel K M, Pieper K S, Granger C B, Wagner G S, Topol E J, Bates E R, Simoons M L, Califf R M
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
J Am Coll Cardiol. 1996 Aug;28(2):305-12. doi: 10.1016/0735-1097(96)00133-7.
We examined the prognostic significance of precordial ST segment depression among patients with an acute inferior myocardial infarction.
Although precordial ST segment depression has been associated with a poor prognosis, this correlation has not been adequately quantified, partly because of small sample sizes and methodologic limitations in previous studies.
We examined the clinical and angiographic outcomes of 16,521 patients with an acute inferior myocardial infarction who underwent thrombolysis in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) study. Patients were classified into those without precordial ST segment depression (n = 6,422 [38.9%]), those with ST segment depression in leads V1 to V3 only (n = 5,850 [35.4%]), those with ST segment depression in leads V4 to V6 only (n = 876 [5.3%]) and those with ST segment depression in both leads V1 to V3 and leads V4 to V6 (n = 3,373 [20.4%]) on initial electrocardiography. Outcome measures included postinfarction complications (second- or third-degree heart block, congestive heart failure or shock) and 30-day and 1-year mortality.
Patients with precordial ST segment depression had larger infarctions, more postinfarction complications and a higher mortality rate than those without precordial ST segment depression (4.7% vs. 3.2% at 30 days; 5.0% vs. 3.4% at 1 year; both p < 0.001), regardless of whether ST segment depression was noted in leads V1 to V6 or in leads V4 to V6. The magnitude of precordial ST segment depression (sum of leads V1 to V6) added significant independent prognostic information after adjustment for clinical risk factors; the risk of 30-day mortality increased by 36% for every 0.5 mV of precordial ST segment depression.
Assessment of the magnitude of precordial ST segment depression is useful for acute risk stratification in patients with an inferior myocardial infarction.
我们研究了急性下壁心肌梗死患者胸前导联ST段压低的预后意义。
尽管胸前导联ST段压低与预后不良相关，但这种相关性尚未得到充分量化，部分原因是既往研究样本量小且存在方法学局限性。
我们在全球应用链激酶和组织型纤溶酶原激活剂治疗闭塞冠状动脉（GUSTO-I）研究中，检查了16521例接受溶栓治疗的急性下壁心肌梗死患者的临床和血管造影结果。根据初始心电图，将患者分为无胸前导联ST段压低者（n = 6422例[38.9%]）、仅V1至V3导联有ST段压低者（n = 5850例[35.4%]）、仅V4至V6导联有ST段压低者（n = 876例[5.3%]）以及V1至V3导联和V4至V6导联均有ST段压低者（n = 3373例[20.4%]）。结局指标包括梗死后并发症（二度或三度房室传导阻滞、充血性心力衰竭或休克）以及30天和1年死亡率。
无论ST段压低出现在V1至V6导联还是V4至V6导联，胸前导联ST段压低的患者比无胸前导联ST段压低的患者梗死面积更大、梗死后并发症更多且死亡率更高（30天时为4.7%对3.2%；1年时为5.0%对3.4%；P均<0.001）。在调整临床危险因素后，胸前导联ST段压低的程度（V1至V6导联总和）增加了显著的独立预后信息；胸前导联ST段压低每增加0.5 mV，30天死亡率风险增加36%。
评估胸前导联ST段压低的程度有助于对下壁心肌梗死患者进行急性风险分层。
