Kurpesa M, Krzeminska-Pakuła M, Bednarkiewicz Z, Trzos E, Peruga J Z, Kośmider M
Department of Cardiology, Jonscher Hospital, Lódz, Poland.
Coron Artery Dis. 1996 Nov;7(11):789-96. doi: 10.1097/00019501-199611000-00001.
The aim of this study was to assess the significance of ST-segment depressions (ST-SD) detected during exercise test or Holter monitoring and to determine which parameters of ST-SD are the most important prognostic factors in patients after myocardial infarction.
The study group consisted of 164 patients (126 men and 38 women) who survived their first uncomplicated myocardial infarction. Twenty-four-hour Holter monitoring on day 10 (+/- 2) after infarction and a treadmill exercise test 1 or 2 days later were performed. The following parameters of ST-SD were taken into consideration: amplitude, localization according to the area of infarction and presence or absence of concomitant angina. Patients were observed for 24 months to assess the occurrence of new cardiac events.
In 78 patients (group I) ST-SD were detected in both Holter monitoring and the exercise test, and in 32 patients (group II) in the exercise test only. Fifty-four patients (group III) were without ST-SD. During follow-up there were 83 cardiac events in group I, 24 in group II and 16 in group III (P < 0.01, group I versus II; P < 0.0001, group I versus III; P < 0.05, group II versus III). In multivariate analysis the presence of ST-SD during Holter monitoring or the exercise test, or both, appeared to be of most prognostic significance (P < 0.0001). The number of new cardiac events was significantly higher in patients with painful ST-SD greater than 3 mm, detected outside the area of infarction (distant ischaemia).
This study shows a significant prognostic value of early post-infarction ischaemia detected by Holter monitoring and an exercise test. Distant, painful ST-SD greater than 3 mm were more powerful determinants of poor prognosis than others. Electrode placement during Holter monitoring appears to be very important, particularly in post-infarction patients.
本研究旨在评估运动试验或动态心电图监测中检测到的ST段压低（ST-SD）的意义，并确定ST-SD的哪些参数是心肌梗死后患者最重要的预后因素。
研究组由164例首次发生非复杂性心肌梗死且存活的患者组成（126例男性和38例女性）。在梗死后第10天（±2天）进行24小时动态心电图监测，并在1或2天后进行平板运动试验。考虑了以下ST-SD参数：幅度、根据梗死区域的定位以及是否伴有心绞痛。对患者进行24个月的观察，以评估新的心脏事件的发生情况。
78例患者（I组）在动态心电图监测和运动试验中均检测到ST-SD，32例患者（II组）仅在运动试验中检测到ST-SD。54例患者（III组）无ST-SD。随访期间，I组有83次心脏事件，II组有24次，III组有16次（P<0.01，I组与II组；P<0.0001，I组与III组；P<0.05，II组与III组）。多变量分析显示，动态心电图监测或运动试验或两者中存在ST-SD似乎具有最大的预后意义（P<0.0001）。梗死区域外检测到的疼痛性ST-SD大于3mm的患者，新的心脏事件数量显著更高（远处缺血）。
本研究表明，动态心电图监测和运动试验检测到的梗死后早期缺血具有显著的预后价值。大于3mm的远处、疼痛性ST-SD比其他因素更能有力地决定预后不良。动态心电图监测期间的电极放置似乎非常重要，尤其是在心肌梗死后患者中。
