Sugiura T, Nagahama Y, Takehana K, Takahashi N, Iwasaka T
The Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Chest. 1997 Apr;111(4):1039-44. doi: 10.1378/chest.111.4.1039.
To examine the clinical significance of precordial ST-segment changes in patients with acute Q-wave inferior wall myocardial infarction.
Prospective evaluation (clinical follow-up) of Q-wave inferior wall myocardial infarction over a 6-year period in patients who fulfilled the inclusion criteria.
Coronary care unit at a university hospital.
Two hundred consecutive patients with acute Q-wave inferior wall myocardial infarction admitted to the coronary care unit within 24 h from the onset of chest pain.
Precordial ST-segment depression resolved <24 h (transient) after admission in 84 patients, lasted > or = 24 h (persistent) in 48 patients, and was absent in 68 patients, while ST-segment elevation in V4R was detected in 60 patients. Seventy-one patients had major in-hospital complications and 18 patients died in the hospital. When nine variables were used in the multivariate analysis, right ventricular dilatation and persistent precordial ST-segment depression were the important factors related to major in-hospital complications, whereas age, alveolar arterial oxygen difference, and persistent precordial ST-segment depression were important for in-hospital deaths.
Left ventricular posterior wall involvement, diagnosed by persistent precordial ST-depression, was an independent and stronger predictor of major in-hospital complications and deaths than right ventricular involvement in patients with acute Q-wave inferior wall myocardial infarction.
探讨急性Q波下壁心肌梗死患者胸前导联ST段改变的临床意义。
对符合纳入标准的患者进行为期6年的Q波下壁心肌梗死前瞻性评估（临床随访）。
大学医院的冠心病监护病房。
24小时内因胸痛发作入住冠心病监护病房的200例连续性急性Q波下壁心肌梗死患者。
84例患者入院后<24小时胸前导联ST段压低消失（短暂性），48例患者持续≥24小时（持续性），68例患者无ST段压低，60例患者检测到V4R导联ST段抬高。71例患者发生主要院内并发症，18例患者死于院内。多因素分析中使用9个变量时，右心室扩张和持续性胸前导联ST段压低是与主要院内并发症相关的重要因素，而年龄、肺泡动脉氧分压差和持续性胸前导联ST段压低对院内死亡很重要。
对于急性Q波下壁心肌梗死患者，持续性胸前导联ST段压低所诊断的左心室后壁受累是比右心室受累更强的主要院内并发症和死亡的独立预测因素。
