Intermittent ST depression and mortality after myocardial infarction.
Intermittent ST depression and mortality after myocardial infarction.
复制标题
心肌梗死后间歇性 ST 压低和死亡率。
DOI：
10.1161/01.cir.85.4.1440
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发表时间：
1992
期刊：
影响因子：
37.8
通讯作者：
Pasternack,BS
中科院分区：
文献类型：
--
作者：
Ruberman,W;Crow,R;Rosenberg,CR;Rautaharju,PM;Shore,RE;Pasternack,BS
背景：我们进行了一项病例对照分析，以确定已完成β受体阻滞剂心脏病发作试验的患者中间歇性ST期抑郁（STD）对死亡率的贡献。方法与结果通过24小时心电图带的计算机分析确定std，即ST水平比所有正常传导复合物的ST中值变化+/- 0.1 mV或更多，持续时间大于或等于1分钟。所有计算机检测到的ST事件都由训练有素的读者进行验证。为了估计与性病相关的死亡风险，261例死亡与年龄、性别、药物状况和急性心肌梗死后的时间相匹配的对照组进行了比较。在包含相关协变量的模型中，STD的相对风险（RR）为1.73（95%置信区间为1.09-2.73）。未治疗组RR为2.56(1.39 ~ 4.71)，服用心得安组RR为0.98（0.48 ~ 2.00）。心绞痛病史虽然不具有独立的显著性，但却增加了这些rr。在安慰剂组中，1-30分钟性病患者的风险梯度为1.91,30分钟以上性病患者的风险梯度为4.33 （p = 0.001，趋势检验）。结论：这项大型研究的结果表明，24小时监测的未经治疗的短暂性STD早期心肌梗死后幸存者的死亡率有显著贡献。在治疗组中效果的消失或降低也提示了一种抗缺血机制，通过这种机制心得安对死亡率有保护作用。确定减少性病是否能提高生存率的试验是有必要的。
BACKGROUNDWe conducted a case-control analysis to determine the contribution made to mortality by intermittent ST depression (STD) among patients enrolled in the already completed Beta Blocker Heart Attack Trial.METHODS AND RESULTSSTD was determined by computer analysis of 24-hour ECG tapes as a change in ST level by +/- 0.1 mV or more from the median value of ST of all normally conducted complexes for greater than or equal to 1 minute. All computer-detected ST events were verified by trained readers. To estimate risk of dying associated with STD, 261 deaths were compared with controls matched for age, sex, drug status, and time elapsed since acute myocardial infarction. In a model including relevant covariates, STD had a relative risk (RR) of 1.73 (95% confidence interval, 1.09-2.73). The RR was 2.56 (1.39-4.71) in untreated patients and 0.98 (0.48-2.00) in propranolol-treated patients. A history of angina, although not independently significant, was found to enhance these RRs. A gradient of risk was shown in the placebo group by a RR of 1.91 in those with 1-30 minutes of STD and 4.33 in those with greater than 30 of STD (p = 0.001, trend test).CONCLUSIONSThe findings in this large study show a significant contribution to mortality among untreated early post-myocardial infarction survivors from transient STD on 24-hour monitoring. The absence or reduction of effect in the treated group also suggests an anti-ischemic mechanism by which propranolol exerts a protective effect on mortality. Trials to determine whether reduction of STD improves survival would be warranted.