急性心肌梗死患者QT离散度的多变量关联因素：梗死相关动脉通畅状态的首要地位。TEAM - 3研究人员。急性心肌梗死中使用埃替巴肽溶栓的第三次试验

Multivariate associates of QT dispersion in patients with acute myocardial infarction: primacy of patency status of the infarct-related artery. TEAM-3 Investigators. Third trial of Thrombolysis with Eminase in Acute Myocardial Infarction.

作者信息

Karagounis L A, Anderson J L, Moreno F L, Sorensen S G

机构信息

University of Utah School of Medicine, LDS Hospital, Salt Lake City 84132, USA.

出版信息

Am Heart J. 1998 Jun;135(6 Pt 1):1027-35. doi: 10.1016/s0002-8703(98)70068-7.

DOI:10.1016/s0002-8703(98)70068-7

PMID:9630107

Abstract

BACKGROUND

QT dispersion (QTd; QT interval maximum minus minimum) has been shown to reflect regional variations in ventricular repolarization and is increased in patients with life-threatening ventricular arrhythmias.

METHODS

To determine correlates of QTd in patients who had had myocardial infarction (MI), 207 patients (158 men, aged 57 +/- 11 years) with acute MI who were treated with alteplase or anistreplase within 2.7 +/- 0.9 hours of symptom onset were studied. Angiograms at a median of 27 hours after thrombolysis showed reperfusion (Thrombolysis in Myocardial Infarction grade > or =2) in 184 (88%) patients. QT was measured in 10 +/- 2 leads on discharge electrocardiograms with a computerized analysis program interfaced with a digitizer. Associations of QTd with 24 variables related to patient characteristics, acute MI, angiography, interventions, and radionuclide ventriculography were evaluated by univariate and multivariate regression.

RESULTS

Univariate associations with QTd (p < or = 0.10) were Thrombolysis in Myocardial Infarction flow grade 0/1 versus 2/3 (QTd = 75 +/- 33 msec vs 53 +/- 22 msec, p < 0.0001), minimal luminal diameter (p = 0.007), left ventricular ejection fraction at discharge (p = 0.007), reinfarction (p = 0.01), number of leads with ST elevation (p = 0.05), end-systolic volume at discharge (p = 0.04), time to peak creatine kinase (p = 0.06), and YST elevation (p = 0.10). Independent associates of QTd were Thrombolysis in Myocardial Infarction grade 0/1 versus 2/3 (p < 0.0001), reinfarction (p = 0.005), and ejection fraction (p = 0.02).

CONCLUSIONS

Successful thrombolysis is associated with less QTd in patients after acute MI. Our results support the hypothesis that QTd after MI depends on reperfusion status, reinfarction, and left ventricular function. Reduction in QTd may be an additional mechanism by which the benefit of thrombolytic therapy is realized.

摘要

背景

QT离散度（QTd；QT间期最大值减去最小值）已被证明可反映心室复极的区域差异，且在有危及生命的室性心律失常患者中增加。

方法

为确定心肌梗死（MI）患者QTd的相关因素，研究了207例急性MI患者（158例男性，年龄57±11岁），这些患者在症状发作后2.7±0.9小时内接受了阿替普酶或茴酰化纤溶酶治疗。溶栓后中位数27小时的血管造影显示，184例（88%）患者出现再灌注（心肌梗死溶栓分级≥2级）。出院心电图上用与数字转换器相连的计算机分析程序在10±2个导联上测量QT。通过单变量和多变量回归评估QTd与24个与患者特征、急性MI、血管造影、干预措施和放射性核素心室造影相关的变量之间的关联。

结果

与QTd单变量相关（p≤0.10）的因素有：心肌梗死溶栓血流分级0/1级与2/3级（QTd = 75±33毫秒对53±22毫秒，p<0.0001）、最小管腔直径（p = 0.007）、出院时左心室射血分数（p = 0.007）、再梗死（p = 0.01）、ST段抬高导联数（p = 0.05）、出院时收缩末期容积（p = 0.04）、肌酸激酶峰值时间（p = 0.06）和YST段抬高（p = 0.10）。QTd的独立相关因素有：心肌梗死溶栓分级0/1级与2/3级（p<0.0001）、再梗死（p = 0.005）和射血分数（p = 0.02）。