下壁心肌梗死患者入院心电图胸前导联ST段压低的预后意义

Prognostic significance of precordial ST segment depression on admission electrocardiogram in patients with inferior wall myocardial infarction.

作者信息

Birnbaum Y, Herz I, Sclarovsky S, Zlotikamien B, Chetrit A, Olmer L, Barbash G I

机构信息

Beilinson Medical Center, Petah-Tiqva, Israel.

出版信息

J Am Coll Cardiol. 1996 Aug;28(2):313-8. doi: 10.1016/0735-1097(96)00173-8.

DOI:10.1016/0735-1097(96)00173-8

PMID:8800103

Abstract

OBJECTIVES

This study assessed retrospectively the correlation between the pattern of precordial ST segment depression on the admission electrocardiogram (ECG) and hospital mortality in patients with an inferior myocardial infarction treated with intravenous thrombolytic therapy.

BACKGROUND

Previous studies have shown that in acute inferior myocardial infarction, ST segment depression in the precordial leads is associated with increased hospital mortality. However, the significance of the different patterns of precordial ST segment depression has been evaluated in only two previous studies.

METHODS

The study included 1,321 patients (1,020 men) who enrolled in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) trial in Israel and received intravenous thrombolytic therapy. Patients with an ST segment elevation > or = 0.1 mV in at least two of the inferior leads were included. Patients were classified into four groups on the basis of their admission ECG: group I = patients with no precordial ST segment depression (n = 346); group II = those for whom the sum of ST segment depression in leads V1 to V3 was greater than that in leads V4 to V6 (n = 700); group III = those for whom the sum of ST depression in leads V1 to V3 was equal to that in leads V4 to V6 (n = 162); group IV = those with maximal ST depression in leads V4 to V6 (n = 113).

RESULTS

The overall hospital mortality rate was 3.6% (48 patients): for groups I, II, III and IV it was 2.9%, 2.8%, 4.3% and 9.7%, respectively. Multivariable logistic regression analysis confirmed that hospital mortality was independently associated with the pattern of precordial ST segment depression. The odd ratios in group IV relative to group I was 2.78 (95% confidence interval 1.26 to 6.13, p = 0.007).

CONCLUSIONS

The risk of mortality is higher in patients with an inferior myocardial infarction and maximal ST segment depression in precordial leads V4 to V6 versus precordial leads V1 to V3 on the admission ECG.

摘要

目的

本研究回顾性评估了接受静脉溶栓治疗的下壁心肌梗死患者入院心电图（ECG）胸前导联ST段压低模式与医院死亡率之间的相关性。

背景

既往研究表明，在急性下壁心肌梗死中，胸前导联ST段压低与医院死亡率增加相关。然而，既往仅有两项研究评估了胸前导联ST段压低不同模式的意义。

方法

本研究纳入了1321例患者（1020例男性），这些患者参加了以色列的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）试验并接受了静脉溶栓治疗。纳入至少两个下壁导联ST段抬高≥0.1mV的患者。根据入院心电图将患者分为四组：I组=无胸前导联ST段压低的患者（n=346）；II组=V1至V3导联ST段压低总和大于V4至V6导联的患者（n=700）；III组=V1至V3导联ST段压低总和等于V4至V6导联的患者（n=162）；IV组=V4至V6导联ST段压低最大的患者（n=113）。