[ST段抬高的快速缓解预示着接受直接经皮腔内冠状动脉成形术治疗的急性心肌梗死患者的功能恢复]

[Rapid resolution of ST-segment elevation predicts functional recovery in acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty].

作者信息

Pucci P D, Antoniucci D, Boddi V, Bolognese L, Buonamici P, Cerisano G, Moschi G, Santini A, Trapani M, Fazzini P F

机构信息

Divisione di Cardiologia, Azienda Ospedaliera Careggi, Firenze.

出版信息

G Ital Cardiol. 1998 May;28(5):554-63.

PMID:9646071

Abstract

OBJECTIVES

This study was designed to prospectively assess the ability of the 12-lead electrocardiogram (ECG) and optimal ECG criteria to predict late functional recovery in patients with acute myocardial infarction (AMI) treated with primary coronary angioplasty (PTCA) BACKGROUND: A simple clinical method to predict clinical outcome in patients with reperfused AMI is highly desirable from a clinical point of view.

METHODS

Seventy-five patients with AMI treated with successful PTCA (TIMI flow grade 3 and residual stenosis < 30%) underwent serial 12-lead ECG before PTCA and every hour for the first 6 hours and then at 9, 12, and 18 hours after PTCA. All patients underwent two-dimensional echocardiography before PTCA and 1 and 6 months later for the evaluation of regional wall motion. The ST segment level in the lead exhibiting the maximal ST elevation (ST increase max) and the sum of the ST segment elevation (sigma ST increases) were calculated on initial ECG and a cut-off values of > or = 50% reduction of ST increases max sigma ST increases elevation and sampling intervals were correlated with late functional recovery. A wall motion score index (WMSI: 1 = normal to 4 = dyskinesia) and 16-segment model were used. Reversible dysfunction was defined as a decrease of > or = 0.22 in WMSI.

RESULTS

At univariate analysis a > or = 50% reduction of both ST increases max and sigma ST increases was related to late functional recovery. Multiple logistic regression analysis revealed that reduction of sigma ST increases was the most powerful predictor of late functional recovery (p = 0.008). A > or = 50% reduction of sigma ST increase within 4 hours of PTCA provided the optimal criterion for predicting late functional recovery.

CONCLUSIONS

Rapid reduction of sigma ST increases elevation is an accurate predictor of left ventricular functional recovery in patients with AMI treated with primary PTCA. Optimal criteria include a reduction in sigma ST increases elevation > or = 50% within 4 hours of PTCA.

摘要

目的

本研究旨在前瞻性评估12导联心电图（ECG）及最佳ECG标准预测接受直接冠状动脉成形术（PTCA）治疗的急性心肌梗死（AMI）患者后期功能恢复的能力。背景：从临床角度来看，非常需要一种简单的临床方法来预测再灌注AMI患者的临床结局。

方法

75例接受成功PTCA治疗（TIMI血流3级且残余狭窄<30%）的AMI患者在PTCA前接受系列12导联ECG检查，在最初6小时内每小时检查1次，然后在PTCA后9、12和18小时检查。所有患者在PTCA前以及1个月和6个月后接受二维超声心动图检查以评估节段性室壁运动。计算初始ECG上显示最大ST段抬高（ST抬高最大值）的导联中的ST段水平以及ST段抬高总和（σST抬高），ST抬高最大值和σST抬高降低≥50%的截断值以及采样间隔与后期功能恢复相关。使用室壁运动评分指数（WMSI：1 =正常至4 =运动障碍）和16节段模型。可逆性功能障碍定义为WMSI降低≥0.22。