Langer A, Krucoff M W, Klootwijk P, Simoons M L, Granger C B, Barr A, Califf R M, Armstrong P W
Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Am Coll Cardiol. 1998 Mar 15;31(4):783-9. doi: 10.1016/s0735-1097(97)00544-5.
We sought to study the relation between recurrent ST segment shift within 6 to 24 h of initial resolution of ST elevation after thrombolytic therapy and 30-day and 1-year mortality.
Rapid and stable resolution of ST segment elevation in relation to thrombolytic therapy in patients with an acute myocardial infarction is an indicator of culprit artery patency. Whether recurrence of ST segment shift during continuous ST monitoring after initial resolution is related to poor prognosis has not been studied.
ST segment monitoring was performed within 30 min after thrombolytic therapy for acute myocardial infarction. The predictive value of a new ST segment shift (assessed as > or = 0.1-mV deviation from the baseline) 6 to 24 h after thrombolytic therapy was studied with respect to 30-day and 1-year mortality.
Of 734 patients, 243 had a new ST segment shift (33%). The 30-day mortality rate in patients with an ST shift (7.8%) was significantly higher than that in patients without an ST shift (2.25%, p = 0.001), as was the 1-year mortality rate (10.3% vs. 5.7%, respectively, p = 0.025). Multivariable analysis revealed an independent predictive value of ST shift with respect to 30-day mortality (p = 0.008), even after consideration of multiple clinical risk factors in the overall Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO)-I mortality model (p = 0.0001). Moreover, the duration of the ST shift bore a direct relation with 1-year mortality (p = 0.008).
Detection of ST segment shift early after thrombolytic therapy for acute myocardial infarction is a simple, noninvasive means of identifying patients at high risk and is superior to other commonly assessed clinical risk factors. Thus, patients with a new ST shift after the first 6 h, but within 24 h, represent a high risk group that may benefit from more aggressive intervention, whereas patients without evidence of an ST shift represent a low risk subgroup.
我们试图研究溶栓治疗后ST段抬高初始缓解6至24小时内ST段反复移位与30天及1年死亡率之间的关系。
急性心肌梗死患者溶栓治疗后ST段抬高的快速稳定缓解是罪犯血管通畅的指标。初始缓解后连续ST段监测期间ST段移位的复发是否与预后不良相关尚未得到研究。
对急性心肌梗死患者进行溶栓治疗后30分钟内进行ST段监测。研究了溶栓治疗后6至24小时新的ST段移位（评估为相对于基线偏差≥0.1 mV）对30天和1年死亡率的预测价值。
734例患者中，243例出现新的ST段移位（33%）。ST段移位患者的30天死亡率（7.8%）显著高于无ST段移位患者（2.25%，p = 0.001），1年死亡率也是如此（分别为10.3%和5.7%，p = 0.025）。多变量分析显示，即使在考虑了全球急性冠状动脉综合征应用链激酶和组织型纤溶酶原激活剂（GUSTO）-I总体死亡率模型中的多个临床危险因素后，ST段移位对30天死亡率仍具有独立预测价值（p = 0.008）（p = 0.0001）。此外，ST段移位的持续时间与1年死亡率直接相关（p = 0.008）。
急性心肌梗死溶栓治疗后早期检测ST段移位是识别高危患者的一种简单、无创方法，优于其他常用评估的临床危险因素。因此，溶栓后6小时但24小时内出现新ST段移位的患者代表高危组，可能从更积极的干预中获益，而无ST段移位证据的患者代表低危亚组。
