Determinants of Prognostically Relevant Intracoronary Electrocardiogram ST-Segment Shift During Coronary Balloon Occlusion
Determinants of Prognostically Relevant Intracoronary Electrocardiogram ST-Segment Shift During Coronary Balloon Occlusion
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DOI：
10.1016/j.amjcard.2012.06.023
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发表时间：
2012-11-01
影响因子：
2.8
通讯作者：
Seiler, Christian
中科院分区：
文献类型：
--
作者：
de Marchi, Stefano Fausto;Streuli, Sabina;Seiler, Christian
定量的冠状动脉内闭塞心电图（ECG） st段移位及其决定因素的预后相关性尚未在人类中进行研究。在765例慢性稳定型冠状动脉疾病患者中，在冠状动脉球囊闭塞1分钟期间，同时获得以下定量测量：冠状动脉内心电图st段移位（由血管成形术导丝记录）、平均主动脉压、平均冠状动脉远端压和平均中心静脉压（CVP）。侧枝血流指数（CFI）计算公式为：（平均冠状动脉远端压减CVP）/（平均主动脉压减CVP）。在平均50 +/- 34个月的随访期间，st段移位= 0.1 mV组的全因累积死亡率显著降低（n = 676, p = 0.0211）。冠状动脉内闭塞心电图st段移位独立相关因素= 0.217（受者工作特征曲线下面积0.647,p < 0.0001）。综上所述，慢性冠状动脉疾病患者短暂冠状动脉闭塞期间无心电图st段移位可降低死亡率，其直接影响因素是右冠状动脉缺血区与左冠状动脉缺血区侧支供应发达以及患者病史中无全身性高血压。(C) 2012爱思唯尔公司版权所有。（美国医学杂志2012；110:1234-1239）
The prognostic relevance of quantitative an intracoronary occlusive electrocardiographic (ECG) ST-segment shift and its determinants have not been investigated in humans. In 765 patients with chronic stable coronary artery disease, the following simultaneous quantitative measurements were obtained during a 1-minute coronary balloon occlusion: intracoronary ECG ST-segment shift (recorded by angioplasty guidewire), mean aortic pressure, mean distal coronary pressure, and mean central venous pressure (CVP). Collateral flow index (CFI) was calculated as follows: (mean distal coronary pressure minus CVP)/(mean aortic pressure minus CVP). During an average follow-up duration of 50 +/- 34 months, the cumulative mortality rate from all causes was significantly lower in the group with an ST-segment shift = 0.1 mV (n = 676, p = 0.0211). Factors independently related to intracoronary occlusive ECG ST-segment shift = 0.217 (area under receiver operating characteristics curve 0.647, p < 0.0001). In conclusion, absence of ECG ST-segment shift during brief coronary occlusion in patients with chronic coronary artery disease conveys a decreased mortality and is directly influenced by a well-developed collateral supply to the right versus left coronary ischemic region and by the absence of systemic hypertension in a patient's history. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1234-1239)