The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study.
The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study.
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无并发症的非 Q 波梗死后 2 周残余心肌缺血的患病率和临床意义：一项前瞻性自然史研究。
DOI：
10.1161/01.cir.73.6.1186
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发表时间：
1986
期刊：
影响因子：
37.8
通讯作者：
D. Kaiser
中科院分区：
文献类型：
--
作者：
R. Gibson;G. Beller;M. Gheorghiade;T. Nygaard;D. Watson;Barry Huey;S. L. Sayre;D. Kaiser
尽管梗死面积较小且左心室功能较好，但非 Q 波心肌梗死 (NQMI) 患者的长期死亡率似乎出人意料地高，最终与 Q 波心肌梗死 (QMI) 患者相当。 NQMI 患者可能会失去最初的预后优势，因为梗塞相关血管的灌注区有更多的存活组织，使心肌更容易发生再梗塞。我们在一项前瞻性研究中测试了这一假设，该研究对 241 名 65 岁或以下的连续患者进行了测试，这些患者均患有急性单纯性心肌梗死，并通过肌酸激酶水平（MB 分数）证实。所有患者均接受常规护理，未接受溶栓治疗或紧急血管成形术。梗死后 10 +/- 3 天进行出院前冠状动脉造影、放射性核素心室造影、24 小时动态心电图监测以及跑步机运动期间的定量铊 201 (201T1) 闪烁扫描。根据适用于第 1、2、3 和 10 天获得的系列心电图的公认标准，梗塞被指定为 QMI (n = 154) 或 NQMI (n = 87)。基线 Norris 冠状动脉预后指数、血管造影危险评分和低度室性心律失常的患病率在各组之间相似，尽管有证据表明 NQMI 与 QMI 相比坏死较少，这反映在较低的峰值肌酸上激酶水平（520 vs 1334 IU/升；p = .0001，4 小时采样）、较高的静息左心室射血分数（53% vs 46%；p = .0001）、较少的运动不能或运动障碍节段（1.2 vs 2.4；p = .0001）以及梗死区持续性 201Tl 缺陷较少（0.9 vs 1.9；p =.0001）。 NQMI 患者的梗塞相关血管较多（54% vs 25%；p 小于 0.0001），并且从梗塞发作到肌酸激酶水平峰值的时间较短（16.9 小时 vs 22.5 小时；p = 0.0001）。重要的是，运动显像中梗死区内定量确定的 201Tl 再分布的患病率和程度在 NQMI 患者中比 QMI 患者中更大（60% vs 36%，p = .007；0.98 vs 0.53 心肌节段，p = .0003）；当根据梗塞相关血管对两组进行分层时，子集分析显示了相同的结果。在 30 个月的中位随访期间，心脏死亡率较低，QMI 组为 8.4%，NQMI 组为 9.2% (p = NS)。（摘要截断为 400 字）
Despite having smaller infarct size and better left ventricular function, patients with non-Q wave myocardial infarction (NQMI) appear to have an unexpectedly high long-term mortality that is ultimately comparable to that of patients with Q-wave myocardial infarction (QMI). Patients with NQMI may lose their initial prognostic advantage because there is more viable tissue in the perfusion zone of the infarct-related vessel, rendering myocardium more prone to reinfarction. We tested this hypothesis in a prospective study of 241 consecutive patients 65 years of age or younger with acute uncomplicated myocardial infarction confirmed by creatine kinase levels (MB fraction). All patients received customary care and none underwent thrombolytic therapy or emergency angioplasty. Predischarge coronary angiography, radionuclide ventriculography, 24 hr Holter monitoring, and quantitative thallium-201 (201T1) scintigraphy during treadmill exercise were performed 10 +/- 3 days after infarction. Infarcts were designated as QMI (n = 154) or NQMI (n = 87) by accepted criteria applied to serial electrocardiograms obtained on days 1, 2, 3, and 10. The baseline Norris coronary prognostic index, angiographic jeopardy scores, and prevalence of Lown grade ventricular arrhythmias were similar between groups despite evidence for less necrosis with NQMI vs QMI, reflected by lower peak creatine kinase levels (520 vs 1334 IU/liter; p = .0001, 4 hr sampling), higher resting left ventricular ejection fraction (53% vs 46%; p = .0001), fewer akinetic or dyskinetic segments (1.2 vs 2.4; p = .0001), and fewer persistent 201Tl defects in the infarct zone (0.9 vs 1.9; p = .0001). Patients with NQMI also had more patent infarct-related vessels (54% vs 25%; p less than .0001) and a shorter time from onset of infarction to peak creatine kinase level (16.9 vs 22.5 hr; p = .0001). Importantly, the prevalence and extent of quantitatively determined 201Tl redistribution within the infarct zone on exercise scintigraphy was greater in patients with NQMI vs those with QMI (60% vs 36%, p = .007; and 0.98 vs 0.53 myocardial segments, p = .0003); when the two groups were stratified on the basis of the infarct-related vessel, subset analysis revealed the same findings. During 30 months median follow-up, cardiac mortality was low, 8.4% in the QMI group and 9.2% in the NQMI group (p = NS).(ABSTRACT TRUNCATED AT 400 WORDS)
预示早期心肌梗塞复发（“延伸”）的因素。
DOI：
10.1016/0002-9149(81)90137-5
发表时间：
1981
期刊：
The American journal of cardiology
影响因子：
--
作者：
Marmor,A;Sobel,BE;Roberts,R
通讯作者：
Roberts,R