Silber S H, Leo P J, Katapadi M
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215, USA.
Acad Emerg Med. 1996 Feb;3(2):147-52. doi: 10.1111/j.1553-2712.1996.tb03403.x.
To determine the proportion of acute myocardial infarction (AMI) patients without ST-segment elevation who subsequently develop ST-segment elevation during their hospital courses; and to compare demographics and presenting features of AMI patient subgroups: those with initial ST-segment elevation, those with in-hospital ST-segment elevation, and those with no ST-segment elevation.
A retrospective cohort analysis of admitted chest pain patients who had a hospital discharge diagnosis of AMI was performed. Each chart was examined for initial ECG interpretation, serial ECG analysis, patient age, gender, cardiac risk factors, in-hospital survival, time between sequential ECGs, and number of ECGs performed within the first 48 hours of hospital admission.
Of the 114 charts reviewed, 20 patients had ECGs meeting thrombolytic criteria on arrival. Of the 94 AMI patients who had nondiagnostic ECGs on arrival, 19 (20%) subsequently developed ECG changes meeting thrombolytic criteria. Seven patients developed these changes within eight hours of the initial ECG, four from eight to 12 hours after, two from 12 to 24 hours after, and six more than 24 hours after. Most patients who had documented AMIs did not develop ECG criteria for thrombolytic therapy during their hospitalizations. Male gender and smoking history were more commonly associated with late ST-segment elevation for those presenting with nondiagnostic ECGs. All the patients who had late diagnostic ECG changes survived to hospital discharge. Serial ECGs were performed more frequently in the group who had initially diagnostic ECGs and least frequently in the group who did not develop ST-segment elevation during their hospitalizations.
Most patients with AMI do not meet ECG criteria for the administration of thrombolytic therapy. A significant minority (20%) of the admitted chest pain patients with subsequently confirmed AMIs developed ECG criteria for thrombolytics during their hospitalizations. Further attention to such patients who have delayed ST-segment elevation is warranted. A standardized in-hospital serial ECG protocol should be considered to identify admitted patients who develop criteria for thrombolytic or other coronary revascularization therapy.
确定非ST段抬高型急性心肌梗死（AMI）患者在住院期间随后出现ST段抬高的比例；并比较AMI患者亚组的人口统计学特征和临床表现：初始ST段抬高患者、住院期间出现ST段抬高患者以及无ST段抬高患者。
对出院诊断为AMI的胸痛住院患者进行回顾性队列分析。检查每份病历的初始心电图解读、系列心电图分析、患者年龄、性别、心脏危险因素、住院生存率、连续心电图之间的时间间隔以及入院后48小时内进行的心电图数量。
在114份回顾的病历中，20例患者入院时心电图符合溶栓标准。在94例入院时心电图未明确诊断的AMI患者中，19例（20%）随后出现符合溶栓标准的心电图改变。7例患者在初始心电图后8小时内出现这些改变，4例在8至12小时后出现，2例在12至24小时后出现，6例在24小时后出现。大多数记录有AMI的患者在住院期间未出现溶栓治疗的心电图标准。对于心电图未明确诊断的患者，男性和吸烟史与晚期ST段抬高更常见相关。所有出现晚期诊断性心电图改变的患者均存活至出院。初始心电图有诊断意义的组中系列心电图检查更频繁，而住院期间未出现ST段抬高的组中系列心电图检查最不频繁。
大多数AMI患者不符合溶栓治疗的心电图标准。在随后确诊为AMI的胸痛住院患者中，有相当少数（20%）在住院期间出现了溶栓治疗的心电图标准。有必要进一步关注这类ST段抬高延迟出现的患者。应考虑采用标准化的住院系列心电图方案，以识别出现溶栓或其他冠状动脉血运重建治疗标准的住院患者。
