Predictors of non-Q-wave acute myocardial infarction in patients with acute ischemic syndromes: an analysis from the Thrombolysis in Myocardial Ischemia (TIMI) III trials.
Predictors of non-Q-wave acute myocardial infarction in patients with acute ischemic syndromes: an analysis from the Thrombolysis in Myocardial Ischemia (TIMI) III trials.
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急性缺血综合征患者非 Q 波急性心肌梗死的预测因素：心肌缺血溶栓 (TIMI) III 试验的分析。
DOI：
10.1016/s0002-9149(99)80707-3
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Braunwald,E
中科院分区：
文献类型：
--
作者：
Cannon,CP;Thompson,B;McCabe,CH;Mueller,HS;Kirshenbaum,JM;Herson,S;Nasmith,JB;Chaitman,BR;Braunwald,E
在急性缺血综合征患者中，已知非Q波急性心肌梗死（AMI）患者的死亡、再梗死和其他发病风险高于不稳定型心绞痛患者。本研究的目的是开发一个临床上有用的预测规则，以帮助区分，在介绍时，与不稳定型心绞痛患者的非Q波AMI。TIMI IIIB试验入组了1，473例在24小时内出现静息缺血性疼痛的患者，这些患者有心电图变化或记录的冠状动脉疾病。33%的患者表现为非Q波AMI，表现为肌酸激酶MB升高。比较非Q波AMI与不稳定型心绞痛患者的50项临床和心电图指标。进行逻辑回归后，4个基线特征独立预测非Q波心肌梗死：既往无冠状动脉血管成形术（比值比[OR] = 3.3，p < 0.001），疼痛持续时间≥60分钟（OR = 2.9，p < 0.001），合格心电图ST段偏移（OR = 2.0，p < 0.001）和近期发作的心绞痛（OR = 1.7，p = 0.002）。利用这4个特征，建立了无Q波AMI的预测规则。对于TIMI III期患者的整个队列，当存在0、1、2、3和4个危险因素时，非Q波AMI患者的百分比分别为7.0%、19.6%、24.4%、49.9%和70.6%（p < 0.001）。因此，在介绍容易识别的特点，可以用来评估非Q波AMI的可能性。
Among patients with acute ischemic syndromes, patients with non-Q-wave acute myocardial infarction (AMI) are known to be at higher risk for death, reinfarction, and other morbidity than those with unstable angina. The aim of this study was to develop a clinically useful prediction rule to assist in distinguishing, at the time of presentation, patients with non-Q-wave AMI from those with unstable angina. The TIMI IIIB trial enrolled 1,473 patients presenting with ischemic pain at rest within 24 hours who had either electrocardiographic changes or documented coronary artery disease. Non-Q-wave AMI on presentation was documented by elevation of creatine kinase-MB in 33% of patients. Fifty clinical and electrocardiographic variables were compared between the patients with non-Q-wave AMI and unstable angina. After performing logistic regression, 4 baseline characteristics independently predicted non-Q-wave myocardial AMI: the absence of prior coronary angioplasty (odds ratio [OR] = 3.3, p < 0.001), duration of pain ≥60 minutes (OR = 2.9, p < 0.001), ST-segment deviation on the qualifying electrocardiogram (OR = 2.0, p < 0.001), and recent-onset angina (OR = 1.7, p = 0.002). Using these 4 characteristics, a prediction rule for non-Q-wave AMI was developed. For the entire cohort of patients in TIMI III, the percentages of patients with non-Q-wave AMI when 0, 1, 2,3, and 4 risk factors were present were 7.0%, 19.6%, 24.4%, 49.9%, and 70.6%, respectively (p < 0.001). Thus, easily identifiable characteristics at presentation can be used to assess the likelihood of non-Q-wave AMI.