Initial Clinical Results Using Intracardiac Electrogram Monitoring to Detect and Alert Patients During Coronary Plaque Rupture and Ischemia
Initial Clinical Results Using Intracardiac Electrogram Monitoring to Detect and Alert Patients During Coronary Plaque Rupture and Ischemia
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DOI：
10.1016/j.jacc.2010.04.053
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发表时间：
2010-09-28
影响因子：
24
通讯作者：
Gibson, C. Michael
中科院分区：
文献类型：
--
作者：
Fischell, Tim A.;Fischell, David R.;Gibson, C. Michael
目的：我们报告了首次在非卧床患者中进行心内st段监测的临床研究，以提醒他们注意与血栓闭塞相关的显著st段移位。背景：尽管从门到球囊的时间有所改善，但从症状到门的时间仍然延迟2至3小时。急性心肌梗死的早期预警可以促使患者立即寻求医学评估。方法对37例急性冠状动脉综合征高危患者进行心内监护。植入的监测器持续评估患者从传统的心脏起搏器右心室尖导联感知到的ST段，并提醒患者注意检测到的缺血事件。结果在随访期间（中位1.52年，126 ~ 974天），4例患者在没有心率升高的情况下，出现st段>= 3 sd的正常值变化。这与医院的即时监测相结合，导致血管造影和/或血管内超声检查，证实血栓性冠状动脉闭塞/斑块破裂。报警到开门的中位时间为19.5 min（分别为6、18、21和60 min）。4例患者在心率升高时提示与需求相关的缺血，反映了血流受限的冠状动脉阻塞。有2例与心律失常有关的缺血假阳性报警，1例由于程序错误而没有提示心导管插入术。结论：偏离患者每日心内st段范围超过3 SD可能是血栓性冠状动脉闭塞的敏感/特异性标志物。对于复发性冠状动脉综合征的高危患者，通常延迟2- 3小时，患者报警的中位报警到门时间为19.5分钟。[J]中华医学会心脏科杂志2010；56:10 9-98)(C) 2010
Objectives We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion.Background Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation.Methods Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events.Results During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of >= 3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization.Conclusions Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays. (J Am Coll Cardiol 2010;56:1089-98) (C) 2010 by the American College of Cardiology Foundation