VERY EARLY RISK STRATIFICATION BY ELECTROCARDIOGRAM AT REST IN MEN WITH SUSPECTED UNSTABLE CORONARY HEART-DISEASE
VERY EARLY RISK STRATIFICATION BY ELECTROCARDIOGRAM AT REST IN MEN WITH SUSPECTED UNSTABLE CORONARY HEART-DISEASE
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DOI：
10.1111/j.1365-2796.1993.tb00746.x
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发表时间：
1993-09-01
影响因子：
11.1
通讯作者：
WEDEL, H
中科院分区：
文献类型：
--
作者：
NYMAN, I;ARESKOG, M;WEDEL, H
目标.根据静息心电图（ECG）和/或疑似不稳定型冠心病发作后的心肌酶水平，确定极早期预后分层的可能性。设计和设置。在八家医院的冠心病监护室对怀疑不稳定型心绞痛或非Q波心肌梗死的男性进行了研究。随访静息心电图和肌酸酐激酶。受试者。总共有911名男性接受了为期12个月的随访。在8136例连续入院的患者中，3365例符合纳入标准。排除了2454例患者，主要是因为较大的心肌损伤，心肌功能不全的迹象，其他严重的心脏或非心脏疾病或心电图无法预测的心前导联ST-T段变化。随访终点为心源性死亡、心肌梗死和严重心绞痛（III级或IV级）。与aECG正常的患者相比，1年心肌梗死或死亡的风险为8%，孤立性负T波的风险为14%（P < 0.05），ST段抬高的风险为16%（P <0.05），ST段压低的风险为18%（P < 0.01），ST段抬高和ST段压低的风险为26%（P < 0.001）。与未来严重心绞痛相关的唯一发现是ST段压低。心电图改变部位在前或下的患者发生心脏事件的风险明显增加。心肌酶水平对未来事件无预测价值。结论.住院初期的静息心电图可为疑似不稳定型冠心病患者提供非常早期和有价值的预后信息。
Objectives. To determine the possibility of very early prognostic stratification based on electrocardiograms (ECGs) at rest and/or cardiac enzyme levels after an episode of suspected unstable coronary heart disease.Design and setting. Men with suspected unstable angina or non-Q-wave myocardial infarction were studied in the coronary care units of eight hospitals. The ECGs at rest and creatinine kinase were followed.Subjects. In total 911 men were followed for 12 months. Of 8136 consecutively admitted, 3365 fulfilled the inclusion criteria. Excluded were 2454 patients, mainly because of a larger myocardial damage, signs of myocardial dysfunction, other serious cardiac or non-cardiac disease or an ECG not possible to interprete regarding ST-T-segment changes in the precordial leads.Main outcome measures. End-points at follow-up were cardiac death, myocardial infarction and severe (class III or IV) angina.Results. Compared to patients with normal a ECG who had an 8% 1 -year risk of myocardial infarction or death, the risk with isolated negative T waves was 14% (P < 0.05), ST elevation 16% (P < 0.05), ST depression 18% (P < 0.01) and the combination of ST elevation and ST depression 26% (P < 0.001). The only finding related to future severe angina was ST depression. The risk of cardiac events was comparably elevated in patients with anterior or inferior site of ECG changes. Cardiac enzyme levels had no predictive value regarding future events. Conclusions. Electrocardiograms at rest obtained during the initial days of hospitalization provide very early and valuble prognostic information in men admitted with suspected unstable coronary heart disease.